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Mortality From HIV and TB Co-Infections Is Higher in Eastern Europe Than in Western Europe and Argentina

April 13, 2010

Noting that TB "is a leading cause of death in HIV-infected patients worldwide," the study authors aimed to evaluate clinical characteristics and outcomes of 1,075 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 multivariable Cox models were used to determine factors associated with death.

At TB diagnosis, patients in Eastern Europe had less advanced immunodeficiency, though a greater proportion had a history of injection drug use, coinfection with hepatitis C, disseminated TB, and infection with drug-resistant TB (P less than 0.0001). Fewer Eastern European patients initiated TB treatment containing at least rifamycin, isoniazid, and pyrazinamide or combination antiretroviral therapy (P less than 0.0001). Mortality at one year was 27 percent in Eastern Europe, compared with 7 percent in Central/Northern Europe, 9 percent in Southern Europe and 11 percent in Argentina (P less than 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 percent (95 percent 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/µl [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 (1.2-2.36)], and rifamycin resistance [2.10 (1.29-3.41)]. "Adjusting for these known confounders did not explain the increased mortality seen in Eastern Europe," noted the investigators.

"The poor outcome of patients with HIV/TB in Eastern Europe deserves further study and urgent public health attention," the researchers concluded.

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Excerpted from:
11.27.2009; Vol. 23, No. 18: P. 2485-2495; The HIV/TB Study Writing Group

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