Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina


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Abstract

Background and objectives:Tuberculosis (TB) is a leading cause of death in HIV-infected patients worldwide. We aimed to study clinical characteristics and outcome of 1075 consecutive patients diagnosed with HIV/TB from 2004 to 2006 in Europe and Argentina.Methods:One-year mortality was assessed in patients stratified according to region of residence, and factors associated with death were evaluated in multivariable Cox models.Results:At TB diagnosis, patients in Eastern Europe had less advanced immunodeficiency, whereas a greater proportion had a history of intravenous drug use, coinfection with hepatitis C, disseminated TB, and infection with drug-resistant TB (P < 0.0001). In Eastern Europe, fewer patients initiated TB treatment containing at least rifamycin, isoniazid, and pyrazinamide or combination antiretroviral therapy (P < 0.0001). Mortality at 1 year was 27% in Eastern Europe, compared with 7, 9 and 11% in Central/Northern Europe, Southern Europe, and Argentina, respectively (P < 0.0001). In a multivariable model, the adjusted relative hazard of death was significantly lower in each of the other regions compared with Eastern Europe: 0.34 (95% confidence interval 0.17–0.65), 0.28 (0.14–0.57), 0.34 (0.15–0.77) in Argentina, Southern Europe and Central/Northern Europe, respectively. Factors significantly associated with increased mortality were CD4 cell count less than 200 cells/μl [2.31 (1.56–3.45)], prior AIDS [1.74 (1.22–2.47)], disseminated TB [2.00 (1.38–2.85)], initiation of TB treatment not including rifamycin, isoniazid and pyrazinamide [1.68 (1.20–2.36)], and rifamycin resistance [2.10 (1.29–3.41)]. Adjusting for these known confounders did not explain the increased mortality seen in Eastern Europe.Conclusion:The poor outcome of patients with HIV/TB in Eastern Europe deserves further study and urgent public health attention.

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