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One-year mortality of HIV-positive patients treated for rifampicin- and isoniazid-susceptible tuberculosis in Eastern Europe, Western Europe, and Latin America

Podlekareva, DN; Schultze, A; Panteleev, A; Skrahina, AM; Miro, JM; Rakhmanova, A; Furrer, H; ... The TB:HIV Study writing Group, .; + view all (2017) One-year mortality of HIV-positive patients treated for rifampicin- and isoniazid-susceptible tuberculosis in Eastern Europe, Western Europe, and Latin America. AIDS , 31 (3) pp. 375-384. 10.1097/QAD.0000000000001333.

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Abstract

OBJECTIVES: The high mortality among HIV/tuberculosis (TB) coinfected patients in Eastern Europe is partly explained by the high prevalence of drug-resistant TB. It remains unclear whether outcomes of HIV/TB patients with rifampicin/isoniazid-susceptible TB in Eastern Europe differ from those in Western Europe or Latin America. METHODS: One-year mortality of HIV-positive patients with rifampicin/isoniazidsusceptible TB in Eastern Europe, Western Europe, and Latin America was analysed and compared in a prospective observational cohort study. Factors associated with death were analysed using Cox regression models. RESULTS: Three hundred and forty-one patients were included (Eastern Europe 127, Western Europe 165, Latin America 49). Proportions of patients with disseminated TB (50, 58, 59%) and initiating rifampicin+isoniazid+pyrazinamide-based treatment (93, 94, 94%) were similar in Eastern Europe, Western Europe, and Latin America respectively, whereas receipt of antiretroviral therapy at baseline and after 12 months was lower in Eastern Europe (17, 39, 39%, and 69, 94, 89%). The 1-year probability of death was 16% (95% confidence interval 11-24%) in Eastern Europe, vs. 4% (2-9%) in Western Europe and 9% (3-21%) in Latin America; P<0.0001. After adjustment for IDU, CD4+ cell count and receipt of antiretroviral therapy, those residing in Eastern Europe were at nearly 3-fold increased risk of death compared with those in Western Europe/Latin America (aHR 2.79 (1.15-6.76); P=0.023). CONCLUSIONS: Despite comparable use of recommended anti-TB treatment, mortality of patients with rifampicin/isoniazid-susceptible TB remained higher in Eastern Europe when compared with Western Europe/Latin America. The high mortality in Eastern Europe was only partially explained by IDU, use of ART and CD4+ cell count. These results call for improvement of care for TB/HIV patients in Eastern Europe.

Type: Article
Title: One-year mortality of HIV-positive patients treated for rifampicin- and isoniazid-susceptible tuberculosis in Eastern Europe, Western Europe, and Latin America
DOI: 10.1097/QAD.0000000000001333
Publisher version: http://dx.doi.org/10.1097/QAD.0000000000001333
Language: English
Additional information: Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. This is the accepted manuscript version of this article published in AIDS; the final published version of record can be found at http://dx.doi.org/10.1097/QAD.0000000000001333. Conference presentation: Results from this study were presented at the 15th European AIDS Conference (EACS), October 21–24, 2015, Barcelona, Spain. Abstract PS2/2.
Keywords: tuberculosis, HIV, treatment, drug -susceptibility testing, death, Eastern Europe, Western Europe, Latin America, TB:HIV study
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Infection and Population Health
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care
URI: http://discovery.ucl.ac.uk/id/eprint/1540905
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