Objectives: The high mortality among HIV/tuberculosis (TB) coinfected patients in Eastern Europe 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 Eastern Europe differ from those in Western Europe or Latin America.
Methods: One-year mortality of HIV-positive patients with rifampicin/isoniazid-susceptible TB in Eastern Europe, Western Europe, and Latin America was analysed and compared in a prospective observational cohort study. Factors associated with death were analysed using Cox regression models
Results: Three hundred and forty-one patients were included (Eastern Europe 127, Western Europe 165, Latin America 49). Proportions of patients with disseminated TB (50, 58, 59%) and initiating rifampicin + isoniazid + pyrazinamide-based treatment (93, 94, 94%) were similar in Eastern Europe, Western Europe, and Latin America respectively, whereas receipt of antiretroviral therapy at baseline and after 12 months was lower in Eastern Europe (17, 39, 39%, and 69, 94, 89%). The 1-year probability of death was 16% (95% confidence interval 11–24%) in Eastern Europe, vs. 4% (2–9%) in Western Europe and 9% (3–21%) in Latin America; P < 0.0001. After adjustment for IDU, CD4+ cell count and receipt of antiretroviral therapy, those residing in Eastern Europe were at nearly 3-fold increased risk of death compared with those in Western Europe/Latin America (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 TB remained higher in Eastern Europe when compared with Western Europe/Latin America. The high mortality in Eastern Europe 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 Eastern Europe.
Correspondence to Daria N. Podlekareva, MD, PhD, Rigshospitalet, University of Copenhagen, CHIP, Department of Infectious Diseases, Section 2100 (CHIP), Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. Tel: +45 35 45 57 57; fax: +45 35 45 57 58; e-mail: firstname.lastname@example.orgemail@example.com
Received 24 April, 2016
Revised 23 October, 2016
Accepted 1 November, 2016