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

D. N. Podlekareva, A. Schultze, A. Panteleev, A. M. Skrahina, J. M. Miro, A. Rakhmanova, H. Furrer, R. F. Miller, A. M.W. Efsen, M. H. Losso, J. Toibaro, A. Vassilenko, E. Girardi, J. D. Lundgren, A. Mocroft, F. A. Post, O. Kirk

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)375-384
Number of pages10
JournalAIDS
Volume31
Issue number3
DOIs
Publication statusPublished - Jan 28 2017

Keywords

  • Death
  • Drug susceptibility testing
  • Eastern Europe
  • HIV
  • Latin America
  • TB:HIV study
  • Treatment
  • Tuberculosis
  • Western Europe

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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    Podlekareva, D. N., Schultze, A., Panteleev, A., Skrahina, A. M., Miro, J. M., Rakhmanova, A., Furrer, H., Miller, R. F., Efsen, A. M. W., Losso, M. H., Toibaro, J., Vassilenko, A., Girardi, E., Lundgren, J. D., Mocroft, A., Post, F. A., & Kirk, O. (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), 375-384. https://doi.org/10.1097/QAD.0000000000001333