Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina.
Details
Serval ID
serval:BIB_5618F80EDF1D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina.
Journal
AIDS
Working group(s)
HIV/TB Study Writing Group
Contributor(s)
Losso M.H., Toibaro J.J., Warley E., Tamayo N., Cristina Ortiz M., Santojanni F., Scapelatto P., Bottaro E., Murano F., Miachans M., Contarelli J., Massera L., Corral J., Hualde M., Miglioranza C., Corti M., Metta H., Casiró A., Cuini R., Laplume H., David D., Marson C., Lupo S., Trape L., Garcia Messina O., Gear O., Ramos Mejía J.M., Toibaro J.J., Bruguera J.M., Karpov I., Vasilenko A., Skrahina E., Skrahin A., Zhavoronok S., Mitsura V., Ruzanov D., Bondarenko V., Suetnov O., Paduto D., Obel N., Gerstoft J., Kronborg G., Pedersen C., Larsen C.S., Pedersen G., Laursen A.L., Nielsen L., Jensen J., Dabis F., Chêne G., Dabis F., Lawson-Ayayi S., Bruyand M., Thiébaut R., Winnock M., Bernard N., Dupon M., Lacoste D., Malvy D., Mercié P., Morlat P., Neau D., Pellegrin J.L., Ragnaud J.M., Moreau J.F., Blanco P., Fleury H., Lafon M.E., Masquelier B., Pellegrin I., Blaizeau M.J., Decoin M., Delveaux S., Dutoit D., Geffard S., Hannapier C., Houinou L., Labarrère S., Lavignolle-Aurillac V., Palmer G., Touchard D., Morlat P., Bernard N., Bonarek M., Bonnet F., Lacombe K., Gellie P., Lacoste D., Paccalin F., Pertusa M.C., Dupon M., Dutronc H., Dauchy F., Lafarie S., Longy-Boursier M., Mercié P., Malvy D., Pistonne T., Receveur M-, Thibaut P., Ragnaud J.M., Cazorla C., Chambon D., De La Taille C., Galpérine T., Neau D., Ochoa A., Pellegrin J.L., Viallard J.F., Caubet O., Nouts C., Couzigou P., Castera L., Loste P., Caunègre L., Bonnal F., Farbos S., Gemain M.C., Ceccaldi J., Tchamgoue S., Witte S.D., Carvalho A.C., Basché R., Hamad I.E., Ricci B.A., Maggiolo F., Ravasio V., Mussini C., Prati F., Castelletti S., Spallanzani L., Antinori A., Antonucci G., Bibbolino C., Bove G., Busi Rizzi E., Cicalini S., Conte A., Cuzzi G., De Mori P., Festa A., Girardi E., Goletti D., Grisetti S., Gualano G., Lauria F.N., Maddaluno R., Migliorisi Ramazzini P., Narciso P., Parracino L., Palmieri F., Petrosillo N., Pucillo L., Puro V., Vanacore P., Urso R., Moroni M., Carosi G., Cauda R., Chiodo F., d'Arminio Monforte A., Di Perri G., Galli M., Iardino R., Ippolito G., Lazzarin A., Mazzotta F., Panebianco R., Pastore G., Perno C.F., Ammassari A., Antinori A., Arici C., Balotta C., Bonfanti P., Capobianchi M.R., Castagna A., Ceccherini-Silberstein F., Cozzi-Lepri A., d'Arminio Monforte A., De Luca A., Gervasoni C., Girardi E., Lo Caputo S., Maggiolo F., Murri R., Mussini C., Puoti M., Torti C., Cozzi-Lepri A., Fanti I., Formenti T., Prosperi M., Montroni M., Giacoemtti A., Costantini A., Riva A., Tirelli U., Martellotta F., Pastore G., Ladisa N., Suter F., Maggiolo F., Chiodo F., Verucchi G., Fiorini C., Carosi G., Cristini G., Torti C., Minardi C., Bertelli D., Quirino T., Abeli C., Manconi P.E., Piano P., Pizzigallo E., Dalessandro M., Carnevale G., Lorenzotti S., Ghinelli F., Sighinolfi L., Leoncini F., Mazzotta F., Pozzi M., Lo Caputo S., Pagano G., Cassola G., Viscoli G., Alessandrini A., Piscopo R., Soscia F., Tacconi L., Orani A., Rossotto R., Tommasi D., Congedo P., Chiodera A., Castelli P., Galli M., Lazzarin A., Rizzardini G., Schlacht I., d'Arminio Monforte A., Ridolfo A.L., Foschi A., Castagna A., Salpietro S., Merli S., Melzi S., Moioli M.C., Cicconi P., Formenti T., Esposito R., Mussini C., Gori A., Borrello A., Abrescia N., Chirianni A., Izzo C.M., De Marco M., Viglietti R., Manzillo E., Ferrari C., Pizzaferri P., Baldelli F., Camanni G., Magnani G., Ursitti M.A., Arlotti M., Ortolani P., Cauda R., Andreoni M., Antinori A., Antonucci G., Narciso P., Tozzi V., Vullo V., De Luca A., Zaccarelli M., Acinapura R., De Longis P., Trotta M.P., Lichtner M., Carletti F., Mura M.S., Madeddu G., Caramello P., Di Perri G., Orofino G.C., Raise E., Ebo F., Pellizzer G., Buonfrate D., Riekstina V., Aldins P., Duiculescu D., Rakhmanova A., Malashenkov E., Kozlov A., Panteleev A., Buzunova S., Miro J.M., García-Goez J.F., Moreno-Camacho A., Martínez J.A., González J., García-Alcaide F., de Lazzari E., Gatell J.M., Sanchez P., Lopez-Colomes J.L., Martínez-Lacasa X., Falcó V., Imaz A., Ocaña I., Vidal R., Sambeat M.A., Caylà J., Moreno-Martínez A., Orcau A., Weber R., Battegay M., Hirschel B., Cavassini M., Bernasconi E., Schmid P., Furrer H., Rickenbach M., Post F., Campbell L., Miller R., Arenas-Pinto A., Chentsova N., Lundgren J.D., Podlekareva D., Kirk O., Mocroft A., Kjaer J., Ellefson M., Chentsova N., Furrer H., Girardi E., Bruyand M., Losso M.H., Lundgren J.D., Panteleev A., Miller R., Miro J.M., Obel N., Post F., Riekstina V., Skrahin A., Toibaro J.J.
ISSN
1473-5571 (Electronic)
ISSN-L
0269-9370
Publication state
Published
Issued date
27/11/2009
Peer-reviewed
Oui
Volume
23
Number
18
Pages
2485-2495
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
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.
One-year mortality was assessed in patients stratified according to region of residence, and factors associated with death were evaluated in multivariable Cox models.
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.
The poor outcome of patients with HIV/TB in Eastern Europe deserves further study and urgent public health attention.
One-year mortality was assessed in patients stratified according to region of residence, and factors associated with death were evaluated in multivariable Cox models.
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.
The poor outcome of patients with HIV/TB in Eastern Europe deserves further study and urgent public health attention.
Keywords
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
Pubmed
Web of science
Open Access
Yes
Create date
30/01/2023 19:28
Last modification date
31/01/2023 6:55
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