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 |
| Open access status: | An open access version is available from UCL Discovery |
| 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 UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1540905 |
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