- 199: AIDS. 2009 Nov 27;23(18):2485-95
Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina.
Podlekareva DN, Mocroft A, Post FA, Riekstina V, Miro JM, Furrer H, Bruyand M, Panteleev AM, Rakhmanova AG, Girardi E, Losso MH, Toibaro JJ, Caylá J, Miller RF, Obel N, Skrahina A, Chentsova N, Lundgren JD, Kirk O; HIV/TB Study Writing Group.
Collaborators (353)Losso MH, Toibaro JJ, 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 JM, Toibaro JJ, Bruguera JM, 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 CS, Pedersen G, Laursen AL, 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 JL, Ragnaud JM, Moreau JF, Blanco P, Fleury H, Lafon ME, Masquelier B, Pellegrin I, Blaizeau MJ, 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 MC, Dupon M, Dutronc H, Dauchy F, Lafarie S, Longy-Boursier M, Mercié P, Malvy D, Pistonne T, Receveur MC, Thibaut P, Ragnaud JM, Cazorla C, Chambon D, De La Taille C, Galpérine T, Neau D, Ochoa A, Pellegrin JL, Viallard JF, Caubet O, Nouts C, Couzigou P, Castera L, Loste P, Caunègre L, Bonnal F, Farbos S, Gemain MC, Ceccaldi J, Tchamgoue S, Witte SD, Carvalho AC, Basché R, Hamad IE, Ricci BA, 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 FN, 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 CF, Ammassari A, Antinori A, Arici C, Balotta C, Bonfanti P, Capobianchi MR, 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 PE, 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 AL, Foschi A, Castagna A, Salpietro S, Merli S, Melzi S, Moioli MC, Cicconi P, Formenti T, Esposito R, Mussini C, Gori A, Borrello A, Abrescia N, Chirianni A, Izzo CM, De Marco M, Viglietti R, Manzillo E, Ferrari C, Pizzaferri P, Baldelli F, Camanni G, Magnani G, Ursitti MA, 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 MP, Lichtner M, Carletti F, Mura MS, Madeddu G, Caramello P, Di Perri G, Orofino GC, 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 JM, García-Goez JF, Moreno-Camacho A, Martínez JA, González J, García-Alcaide F, de Lazzari E, Gatell JM, Sanchez P, Lopez-Colomes JL, Martínez-Lacasa X, Falcó V, Imaz A, Ocaña I, Vidal R, Sambeat MA, 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 JD, Podlekareva D, Kirk O, Mocroft A, Kjaer J, Ellefson M, Chentsova N, Furrer H, Girardi E, Bruyand M, Losso MH, Lundgren JD, Panteleev A, Miller R, Miro JM, Obel N, Post F, Riekstina V, Skrahin A, Toibaro JJ.
University of Copenhagen, Copenhagen HIV Programme, The Panum Institute/Building 21.1, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. dpo@cphiv.dk
Comment in:
AIDS. 2009 Nov 27;23(18):2533-4.
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.