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

Daria N Podlekareva; Amanda Mocroft; Frank A Post; Vija Riekstina; Jose M Miro; Hansjakob Furrer; Mathias Bruyand; Alexander M Panteleev; Aza G Rakhmanova; Enrico Girardi; Marcello H Losso; Javier J Toibaro; Joan Caylá; Rob F Miller; Niels Obel; Alena Skrahina; Nelly Chentsova; Jens D Lundgren; Ole Kirk; HIV/TB Study Writing Group

doi:10.1097/QAD.0b013e3283326879

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

AIDS. 2009 Nov 27;23(18):2485-95. doi: 10.1097/QAD.0b013e3283326879.

Collaborators

HIV/TB Study Writing Group:
M H Losso, J J Toibaro, E Warley, N Tamayo, M Cristina Ortiz, F Santojanni, P Scapelatto, E Bottaro, F Murano, M Miachans, J Contarelli, L Massera, J Corral, M Hualde, C Miglioranza, M Corti, H Metta, A Casiró, R Cuini, H Laplume, D David, C Marson, S Lupo, L Trape, O Garcia Messina, O Gear, J M Ramos Mejía, J J Toibaro, J M Bruguera, I Karpov, A Vasilenko, E Skrahina, A Skrahin, S Zhavoronok, V Mitsura, D Ruzanov, V Bondarenko, O Suetnov, D Paduto, N Obel, J Gerstoft, G Kronborg, C Pedersen, C S Larsen, G Pedersen, A L Laursen, L Nielsen, J Jensen, F Dabis, G Chêne, F Dabis, S Lawson-Ayayi, M Bruyand, R Thiébaut, M Winnock, N Bernard, M Dupon, D Lacoste, D Malvy, P Mercié, P Morlat, D Neau, J L Pellegrin, J M Ragnaud, J-F Moreau, P Blanco, H Fleury, M E Lafon, B Masquelier, I Pellegrin, M J Blaizeau, M Decoin, S Delveaux, D Dutoit, S Geffard, C Hannapier, L Houinou, S Labarrère, V Lavignolle-Aurillac, G Palmer, D Touchard, P Morlat, N Bernard, M Bonarek, F Bonnet, K Lacombe, P Gellie, D Lacoste, F Paccalin, M C Pertusa, M Dupon, H Dutronc, F Dauchy, S Lafarie, M Longy-Boursier, P Mercié, D Malvy, T Pistonne, M -C Receveur, P Thibaut, J M Ragnaud, C Cazorla, D Chambon, C De La Taille, T Galpérine, D Neau, A Ochoa, J L Pellegrin, J F Viallard, O Caubet, C Nouts, P Couzigou, L Castera, P Loste, L Caunègre, F Bonnal, S Farbos, M C Gemain, J Ceccaldi, S Tchamgoue, S De Witte, A C Carvalho, R Basché, I E Hamad, B A Ricci, F Maggiolo, V Ravasio, C Mussini, F Prati, S Castelletti, L Spallanzani, A Antinori, G Antonucci, C Bibbolino, G Bove, E Busi Rizzi, S Cicalini, A Conte, G Cuzzi, P De Mori, A Festa, E Girardi, D Goletti, S Grisetti, G Gualano, F N Lauria, R Maddaluno, P Migliorisi Ramazzini, P Narciso, L Parracino, F Palmieri, N Petrosillo, L Pucillo, V Puro, P Vanacore, R Urso, M Moroni, G Carosi, R Cauda, F Chiodo, A d'Arminio Monforte, G Di Perri, M Galli, R Iardino, G Ippolito, A Lazzarin, F Mazzotta, R Panebianco, G Pastore, C F Perno, A Ammassari, A Antinori, C Arici, C Balotta, P Bonfanti, M R Capobianchi, A Castagna, F Ceccherini-Silberstein, A Cozzi-Lepri, A d'Arminio Monforte, A De Luca, C Gervasoni, E Girardi, S Lo Caputo, F Maggiolo, R Murri, C Mussini, M Puoti, C Torti, A Cozzi-Lepri, I Fanti, T Formenti, M Prosperi, M Montroni, A Giacoemtti, A Costantini, A Riva, U Tirelli, F Martellotta, G Pastore, N Ladisa, F Suter, F Maggiolo, F Chiodo, G Verucchi, C Fiorini, G Carosi, G Cristini, C Torti, C Minardi, D Bertelli, T Quirino, C Abeli, P E Manconi, P Piano, E Pizzigallo, M Dalessandro, G Carnevale, S Lorenzotti, F Ghinelli, L Sighinolfi, F Leoncini, F Mazzotta, M Pozzi, S Lo Caputo, G Pagano, G Cassola, G Viscoli, A Alessandrini, R Piscopo, F Soscia, L Tacconi, A Orani, R Rossotto, D Tommasi, P Congedo, A Chiodera, P Castelli, M Galli, A Lazzarin, G Rizzardini, I Schlacht, A d'Arminio Monforte, A L Ridolfo, A Foschi, A Castagna, S Salpietro, S Merli, S Melzi, M C Moioli, P Cicconi, T Formenti, R Esposito, C Mussini, A Gori, A Borrello, N Abrescia, A Chirianni, C M Izzo, M De Marco, R Viglietti, E Manzillo, C Ferrari, P Pizzaferri, F Baldelli, G Camanni, G Magnani, M A Ursitti, M Arlotti, P Ortolani, R Cauda, M Andreoni, A Antinori, G Antonucci, P Narciso, V Tozzi, V Vullo, A De Luca, M Zaccarelli, R Acinapura, P De Longis, M P Trotta, M Lichtner, F Carletti, M S Mura, G Madeddu, P Caramello, G Di Perri, G C Orofino, E Raise, F Ebo, G Pellizzer, D Buonfrate, V Riekstina, P Aldins, D Duiculescu, A Rakhmanova, E Malashenkov, A Kozlov, A Panteleev, S Buzunova, J M Miro, J F García-Goez, A Moreno-Camacho, J A Martínez, J González, F García-Alcaide, E de Lazzari, J M Gatell, P Sanchez, J L Lopez-Colomes, X Martínez-Lacasa, V Falcó, A Imaz, I Ocaña, R Vidal, M A Sambeat, J Caylà, A Moreno-Martínez, A Orcau, R Weber, M Battegay, B Hirschel, M Cavassini, E Bernasconi, P Schmid, H Furrer, M Rickenbach, F Post, L Campbell, R Miller, A Arenas-Pinto, N Chentsova, J D Lundgren, D Podlekareva, O Kirk, A Mocroft, J Kjaer, M Ellefson, N Chentsova, H Furrer, E Girardi, M Bruyand, M H Losso, J D Lundgren, A Panteleev, R Miller, J M Miro, N Obel, F Post, V Riekstina, A Skrahin, J J Toibaro

Affiliation

¹ University of Copenhagen, Copenhagen HIV Programme, The Panum Institute/Building 21.1, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. dpo@cphiv.dk

PMID: 19898216
DOI: 10.1097/QAD.0b013e3283326879

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/microl [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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Argentina / epidemiology
CD4 Lymphocyte Count
Europe / epidemiology
Europe, Eastern / epidemiology
Female
HIV Infections / drug therapy
HIV Infections / immunology
HIV Infections / mortality*
HIV-1*
Humans
Male
Population Surveillance
Proportional Hazards Models
Risk Factors
Tuberculosis / drug therapy
Tuberculosis / immunology
Tuberculosis / mortality*