Abstract
Mortality of HIV/tuberculosis (TB) patients in Eastern Europe is high. Little is known about their causes of death.
This study aimed to assess and compare mortality rates and cause of death in HIV/TB patients across Eastern Europe and Western Europe and Argentina (WEA) in an international cohort study. Mortality rates and causes of death were analysed by time from TB diagnosis (<3 months, 3–12 months or >12 months) in 1078 consecutive HIV/TB patients. Factors associated with TB-related death were examined in multivariate Poisson regression analysis.
347 patients died during 2625 person-years of follow-up. Mortality in Eastern Europe was three- to ninefold higher than in WEA. TB was the main cause of death in Eastern Europe in 80%, 66% and 61% of patients who died <3 months, 3–12 months or >12 months after TB diagnosis, compared to 50%, 0% and 15% in the same time periods in WEA (p<0.0001). In multivariate analysis, follow-up in WEA (incidence rate ratio (IRR) 0.12, 95% CI 0.04–0.35), standard TB-treatment (IRR 0.45, 95% CI 0.20–0.99) and antiretroviral therapy (IRR 0.32, 95% CI 0.14–0.77) were associated with reduced risk of TB-related death.
Persistently higher mortality rates were observed in HIV/TB patients in Eastern Europe, and TB was the dominant cause of death at any time during follow-up. This has important implications for HIV/TB programmes aiming to optimise the management of HIV/TB patients and limit TB-associated mortality in this region.
Abstract
High TB-related death rates in HIV patients in Eastern Europe require measures to improve their clinical management http://ow.ly/q7XcD
Footnotes
Support statement: Data collection in Eastern Europe (Belarus, Latvia, Russia and Ukraine) and Argentina was funded by the Copenhagen HIV Programme and the EuroSIDA study. Primary support for EuroSIDA is provided by the European Commission BIOMED 1 (grant number CT94-1637), BIOMED 2 (grant number CT97-2713), the 5th Framework (grant number QLK2-2000-00773) and the 6th Framework (grant number LSHP-CT-2006-018632) programmes. Current support also includes unrestricted grants from Bristol-Myers Squibb, GlaxoSmithKline, Roche, Gilead, Pfizer, Merck and Co., Tibotec, and Boehringer-Ingelheim. Data collection in Western Europe was self-funded by the participating cohorts: Aquitaine Cohort, France; Danish HIV Cohort, Denmark; and Mortimer Market Hospital and King’s College Hospital, London, UK. In Italy, the INMI L. Spallanzani cohort was supported in part by the Ministry of Health AIDS Project, grant number 49H79. In Spain the study was funded in part by Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Spanish Network for the AIDS Research (RD06/006), Madrid, Spain, and Agencia de Salud Pública de Barcelona, and in addition personal Intensification Research Grant to J.M. Miro in 2011 from the Instituto de Salud Carlos III, Madrid and the Departament de Salut de la Generalitat de Catalunya, Barcelona (grant number INT10/219, I3SNS and PRICS programmes). In Switzerland the study was financed in the framework of the Swiss HIV Cohort Study (www.shcs.ch), supported by the Swiss National Science Foundation (grant number 33CS30_134277). D.N. Podlekareva was financed through a postdoctoral scholarship from the Danish Council for Independent Research, Denmark.
Conflict of interest: Disclosures can be found alongside the online version of this article at erj.ersjournals.com
- Received September 1, 2012.
- Accepted April 25, 2013.
- ©ERS 2014