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

Podlekareva D. N.; Panteleev A. M.; Grint D.; Post F. A.; Miro J. M.; Bruyand M.; Furrer H.; Obel N.; Girardi E.; Vasilenko A.; Losso M. H.; Arenas-Pinto A.; Cayla J.; Rakhmanova A.; Zeltina I.; Werlinrud A. M.; Lundgren J. D.; Mocroft A.; Kirk O.; Toibaro J. J.; Warley E.; Tamayo N.; Cristina Ortiz M.; Scapelatto P.; Bottaro E.; Murano F.; Miachans M.; Contarelli J.; Massera L.; Corral J.; Hualde M.; Miglioranza C.; Corti M.; Metta H.; Casiro A.; Cuini R.; Laplume H.; David D.; Marson C.; Lupo S.; Trape L.; Garcia Messina O.; Gear O.; Bruguera J. M.; Karpov I.; Skrahina E.; Skrahin A.; Mitsura V.; Kozorez E.; Ruzanov D.; Bondarenko V.; Suetnov O.; Paduto D.; Dabis F.; Matteelli A.; Carvalho A. C.; Basche R.; Hamad I. E.; Ricci B. A.; Maggiolo F.; Ravasio V.; Mussini C.; Prati F.; Castelletti S.; Spallanzani L.; Antinori A.; Antonucci G.; Bibbolino C.; Bove G.; Busi Rizzi E.; Cicalini S.; Conte A.; Cuzzi G.; De Mori P.; Festa A.; Goletti D.; Grisetti S.; Gualano G.; Lauria F. N.; Maddaluno R.; Migliorisi Ramazzini P.; Narciso P.; Parracino L.; Palmieri F.; Petrosillo N.; Pucillo L.; Puro V.; Vanacore P.; Urso R.; d'Arminio Monforte A.; Riekstina V.; Aldins P.; Duiculescu D.; Malashenkov E.; Kozlov A.; Buzunova S.; Manzardo C.; Garcia-Goez J. F.; Moreno-Camacho A.; Martinez J. A.; Gonzalez J.; Garcia-Alcaide F.; Perez I.; Gatell J. M.; Sanchez P.; Lopez-Colomes J. L.; Martinez-Lacasa X.; Falco V.; Imaz A.; Ocana I.; Vidal R.; Sambeat M. A.; Cayla J.; Moreno-Martinez A.; Millet J. P.; Fina L.; del Bano L.; Orcau A.; Barth J.; Battegay M.; Bernasconi E.; Boni J.; Bucher H. C.; Burton-Jeangros C.; Calmy A.; Cavassini M.; Cellerai C.; Egger M.; Elzi L.; Fehr J.; Fellay J.; Flepp M.; Fux C. A.; Gorgievski M.; Gunthard H.; Haerry D.; Hasse B.; Hirsch H. H.; Hirschel B.; Hosli I.; Kahlert C.; Kaiser L.; Keiser O.; Kind C.; Klimkait T.; Kovari H.; Ledergerber B.; Martinetti G.; Martinez de Tejada B.; Metzner K.; Muller N.; Nadal D.; Pantaleo G.; Rauch A.; Regenass S.; Rickenbach M.; Rudin C.; Schmid P.; Schultze D.; Schoni-Affolter F.; Schupbach J.; Speck R.; Taffe P.; Tarr P.; Telenti A.; Trkola A.; Vernazza P.; Weber R.; Yerly S.; Campbell L.; Miller R.; Chentsova N.; Podlekareva D.; Kjaer J.; Duiculesku D.

doi:10.1183/09031936.00138712

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.