A new health care index predicts short term mortality for TB and HIV co-infected people

A. O. Roen, D. Podlekareva, R. F. Miller, A. Mocroft, A. Panteleev, A. Skrahina, J. M. Miro, J. A. Cayla, S. Tetradov, E. Derisova, H. Furrer, M. H. Losso, A. Vassilenko, E. Girardi, J. D. Lundgren, F. A. Post, O. Kirk

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Using 2004-2007 TB:HIV Study data<x/> from Europe and Latin America, we previously generated a health care index (HCI) for TB and HIV co-infected people. With improvements in diagnostic and management practices, we have now updated the HCI with new data.METHODS: We evaluated nine aspects of health care in Cox proportional hazards models on time from TB diagnosis to death. Kaplan-Meier methods were used to estimate the probability of death by HCI quartile.RESULTS: Of 1396 eligible individuals (72% male, 59% from Eastern Europe), 269 died within 12 months. Use of rifamycin/isoniazid/pyrazinamide-based treatment (HR 0.67, 95% CI 0.50-0.89), TB drug susceptibility testing (DST) and number of active TB drugs (DST + <3 drugs (HR 1.09, 95% CI 0.80-1.48), DST + ≥3 drugs (HR 0.49, 95% CI 0.35-0.70) vs. no DST), recent HIV-RNA measurement (HR 0.64, 95% CI 0.50-0.82) and combination antiretroviral therapy use (HR 0.72, 95% CI 0.53-0.97) were associated with mortality. These factors contributed respectively 5, -1, 8, 5 and 4 to the HCI<x/>. Lower HCI was associated with an increased probability of death; 30% (95% CI 26-35) vs. 9% (95% CI 6-13) in the lowest vs. the highest quartile.<x/>CONCLUSION: We found five potentially modifiable health care components that were associated with mortality among TB-HIV positive individuals. Validation of our HCI in other TB cohorts could enhance our findings.

Original languageEnglish
Pages (from-to)956-962
Number of pages7
JournalThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Volume24
Issue number9
DOIs
Publication statusPublished - Sep 1 2020

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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