One-year mortality of HIV-positive patients treated for rifampicin- and isoniazid- susceptible tuberculosis in Eastern Europe, Western Europe and Latin America. AIDS
Podlekareva et al. on behalf of the TB:HIV Study writing Group aimed to assess and compare mortality rates of HIV patients with drug susceptible tuberculosis (TB) across regions and identify risk factors associated with mortality.
Proportion of patients on antiretroviral therapy (ART) was significantly higher at any time point in Western Europe and in Latin America compared to Eastern Europe. At 12 months 94% and 89% of patients in Western Europe and Latin America, respectively, were on ART compared with 69% in Eastern Europe (P<0.001). At 12 months after TB diagnosis, 48% of patients on ART in Eastern Europe had HIV RNA less than 500 copies/ml compared with 86% and 71% in Western Europe and Latin America, respectively (P<0.001). The 1-year probability of death was 16% in Eastern Europe, vs. 4% in Western Europe and 9% 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.
In conclusion, this study documents a high mortality among HIV-positive patients with drug susceptible TB in Eastern Europe despite widespread use of WHO recommended anti-TB treatment regimens as initial therapy. Management of HIV infection was suboptimal in this region, but did not fully explain the high mortality. These results call for improvement of care for TB/HIV patients in Eastern Europe.