Objectives: The high mortality among HIV/tuberculosis (TB) co-infected patients in Eastern Europe (EE) is partly explained by the high prevalence of drug-resistant TB. It remains unclear whether outcomes of HIV/TB patients with rifampicin/isoniazid-susceptible TB in EE differ from those in Western Europe (WE) or Latin America (LA).
Methods: One-year mortality of HIV-positive patients with rifampicin/isoniazid-susceptible TB in EE, WE and LA was analysed and compared in a prospective observational cohort study. Factors associated with death were analysed using Cox regression models
Results: 341 patients were included (EE 127, WE 165, LA 49). Proportions of patients with disseminated TB (50%, 58%, 59%) and initiating rifampicin + isoniazid + pyrazinamide-based treatment (93%, 94%, 94%) were similar in EE, WE and LA respectively, while receipt of antiretroviral therapy (ART) at baseline and after 12 months was lower in EE (17%, 39%, 39%, and 69%, 94%, 89%). The one-year probability of death was 16% (95%CI 11%-24%) in EE, vs. 4% (2%-9%) in WE and 9% (3%-21%) in LA; p < 0.0001. After adjustment for injecting drug use (IDU), CD4-cell count and receipt of ART, those residing in EE were at nearly 3-fold increased risk of death compared to those in WE/LA (aHR 2.79 (1.15-6.76); p = 0.023).
Conclusions: Despite comparable use of recommended anti-TB treatment, mortality of patients with rifampicin/isoniazid-susceptible tuberculosis remained higher in EE when compared with WE/LA. The high mortality in EE was only partially explained by IDU, use of ART and CD4 cell count. These results call for improvement of care for TB/HIV patients in EE.
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