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.