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  • Oral presentation
  • Open Access

O412 Factors associated with poor clinical outcome among HIV-infected patients with tuberculosis (TB) in Europe and Argentina. The HIV/TB collaborative study

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Journal of the International AIDS Society200811 (Suppl 1) :O39

https://doi.org/10.1186/1758-2652-11-S1-O39

  • Published:

Keywords

  • Relative Hazard
  • Health Attention
  • O412 Factor
  • Adjusted Relative Hazard

Purpose of the study

TB is a common and potentially fatal co-infection among HIV-infected patients worldwide. We aimed to evaluate potential regional differences in patient characteristics and clinical management and their influence on the one-year mortality rate after a TB diagnosis in HIV-infected patients across Europe and Argentina.

Methods

1,075 consecutive HIV-patients who started treatment for TB between January 2004 and December 2006 in 47 clinics across Europe and Argentina were identified. Patients were stratified according to region of residence: Argentina (A), Southern Europe (S), Central/Northern Europe (CN), or Eastern Europe (E). Deaths among HIV/TB co-infected patients within 12 months of TB diagnosis, and factors associated with death, were analysed.

Summary of results

At TB diagnosis, there were profound differences in patient characteristics, usage of anti-TB and combination antiretroviral therapy (cART), and anti-TB drug resistance in E compared with the other regions (Table 1). Significantly fewer patients in E initiated cART within the first year after TB diagnosis (Table 1), and multi-drug resistant TB was more common in E (12% [31 of 252 patients with data on anti-TB resistance]) compared to A, S and CN (3%, 2% and 3% respectively, p = 0.0002). Progression to death was significantly faster in E compared to other regions (Figure 1). In multivariable Cox models, the adjusted relative hazard of death (RH, compared with E) was 0.44 (95% CI 0.22–0.88), 0.33 (0.17–0.66), 0.46 (0.20–1.05) in A, S and CN, respectively. Other factors significantly associated with increased mortality were: CD4 count <200 cells/mm3 vs. >200 cells/mm3 [2.27 (1.52–3.40)], prior AIDS vs. no AIDS [1.84 (1.29–2.62)], and disseminated TB vs. not disseminated TB [2.01 (1.14–3.56)]. Patients who started anti-TB treatment with at least four first-line drugs had a significantly lower risk of death [0.50 (0.31–0.81)], as did patients with no resistance to anti-TB drugs [0.48 (0.28–0.79)].

Table 1

 

A (n = 115)

S (n = 210)

CN (n = 168)

E (n = 582)

P-value

Caucasians (%)

23

56

33

83

<0.0001

Injecting drug use (%)

37

35

14

80

<0.0001

>4 1st line anti-TB drugs in initial regimen (%)

83

63

77

25

<0.0001

>1 2nd line anti-TB drug in initial regimen (%)

12

15

10

64

<0.0001

Resistance to any anti-TB drug (%, 513 tests)

7

13

7

50

<0.0001

CD4 count at TB diagnosis (cells/mm3, median, inter-quartile range)

92 (41–228)

146 (55–291)

145 (54–284)

212 (89–463)

<0.0001

On cART at TB diagnosis (%)

26

25

34

8

<0.0001

On cART 12 months after TB diagnosis (%)

77

71

75

31

<0.0001

Figure 1
Figure 1

Progression to death within 1 year of TB diagnosis.

Conclusion

In conclusion, there were substantial differences in the clinical management of HIV-TB co-infected patients across Europe and Argentina, including less use of cART and more extensive use of second-line anti-TB drugs, presumably partly due to widespread TB drug resistance in populations from E. These factors may partly explain the 3–4 fold higher one-year mortality rate after a TB diagnosis in this region, and deserve immediate public health attention.

Authors’ Affiliations

(1)
Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark
(2)
Royal Free and University College Medical School, London, UK
(3)
King's College London School of Medicine, London, UK
(4)
State Agency of TB and Lung Diseases, Riga, Latvia
(5)
Hosp. Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
(6)
University Hospital of Bern, Bern, Switzerland
(7)
INSERM, U 897, "epidemiology and biostatistics", Bordeaux, France
(8)
TB Hospital #2, St. Petersburg, Russian Federation
(9)
Instituto Nazionale Malattie Infettive L Spallanzani, Rome, Italy
(10)
Hospital JM Ramos Mejia, Buenos Aires, Argentina
(11)
Barcelona TB Research Unit, Barcelona, Spain
(12)
Mortimer Market Centre, London, UK
(13)
Dept of Infectious Diseases; Rigshospitalet, Copenhagen, Denmark
(14)
Research Institute of Pulmonology and Pulmonary Tuberculosis, Minsk, Belarus
(15)
Botkin Hospital of Infectious Diseases, St. Petersburg, Russian Federation
(16)
Copenhagen HIV Programme, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark

Copyright

© Podlekareva et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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