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Short- and long-term mortality and causes of death in HIV/tuberculosis patients in Europe.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Podlekareva Daria N, Panteleev Alexander M, Grint Daniel, Post Frank A, Miro Jose M, Bruyand Mathias, Furrer Hansjakob, Obel Niels, Girardi Enrico, Vasilenko Anna, Losso Marcelo H, Arenas-Pinto Alejandro, Caylá Joan, Rakhmanova Aza, Zeltina Indra, Werlinrud Anne Marie, Lundgren Jens D, Mocroft Amanda, Kirk Ole, HIV/TB study group,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal The European respiratory journal
Volume (Issue) 43(1)
Page(s) 166 - 77
Title of proceedings The European respiratory journal
DOI 10.1183/09031936.00138712

Open Access

URL http://doi.org/10.1183/09031936.00138712
Type of Open Access Publisher (Gold Open Access)

Abstract

Mortality of HIV/tuberculosis (TB) patients in Eastern Europe is high. Little is known about their causes of death. This study aimed to assess and compare mortality rates and cause of death in HIV/TB patients across Eastern Europe and Western Europe and Argentina (WEA) in an international cohort study. Mortality rates and causes of death were analysed by time from TB diagnosis (<3 months, 3-12 months or >12 months) in 1078 consecutive HIV/TB patients. Factors associated with TB-related death were examined in multivariate Poisson regression analysis. 347 patients died during 2625 person-years of follow-up. Mortality in Eastern Europe was three- to ninefold higher than in WEA. TB was the main cause of death in Eastern Europe in 80%, 66% and 61% of patients who died <3 months, 3-12 months or >12 months after TB diagnosis, compared to 50%, 0% and 15% in the same time periods in WEA (p<0.0001). In multivariate analysis, follow-up in WEA (incidence rate ratio (IRR) 0.12, 95% CI 0.04-0.35), standard TB-treatment (IRR 0.45, 95% CI 0.20-0.99) and antiretroviral therapy (IRR 0.32, 95% CI 0.14-0.77) were associated with reduced risk of TB-related death. Persistently higher mortality rates were observed in HIV/TB patients in Eastern Europe, and TB was the dominant cause of death at any time during follow-up. This has important implications for HIV/TB programmes aiming to optimise the management of HIV/TB patients and limit TB-associated mortality in this region.
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