Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients

Podlekareva, D. N.; Grint, D.; Post, F. A.; Mocroft, A.; Panteleev, A. M.; Miller, R. F.; Miro, J. M.; Bruyand, M.; Furrer, H.; Riekstina, V.; Girardi, E.; Losso, M. H.; Cayla, J. A.; Malashenkov, E. A.; Obel, N.; Skrahina, A. M.; Lundgren, J. D.; Kirk, O.; Chentsova, N.; Duiculesku, D.; Toibaro, J. J.; Warley, E.; Tamayo, N.; Ortiz, M. C.; 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.; Vasilenko, A.; Skrahina, E.; 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.; Aldins, P.; Zeltina, I.; Duiculescu, D.; Rakhmanova, A.; 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 Mutua de Terrassa, J. L.; Martinez-Lacasa, X.; Imaz, V. F.; Ocana, I.; Vidal, R.; Sambeat, M. A.; 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.; Arenas-Pinto, A.; Kjaer, J.; Ellefson, M.; Duiculesku, D.

doi:10.5588/ijtld.12.0224

OBJECTIVES: To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome. METHODS: A total of 1061 HIV patients diagnosed with TB in four regions, Central/Northern, Southern and Eastern Europe and Argentina, between January 2004 and December 2006 were enrolled in the TB-HIV study. A weighted HCI score (range 0-5), based on independent prognostic factors identified in multivariable Cox models and the final score, included performance of TB drug susceptibility testing (DST), an initial TB regimen containing a rifamycin, isoniazid and pyrazinamide, and start of combination antiretroviral treatment (cART). RESULTS: The mean HCI score was highest in Central/Northern Europe (3.2, 95%CI 3.1-3.3) and lowest in Eastern Europe (1.6, 95%CI 1.5-1.7). The cumulative probability of death 1 year after TB diagnosis decreased from 39% (95%CI 31-48) among patients with an HCI score of 0, to 9% (95%CI 6-13) among those with a score of ≥4. In an adjusted Cox model, a 1-unit increase in the HCI score was associated with 27% reduced mortality (relative hazard 0.73, 95%CI 0.64-0.84). CONCLUSIONS: Our results suggest that DST, standard anti-tuberculosis treatment and early cART may improve outcome for TB-HIV patients. The proposed HCI score provides a tool for future research and monitoring of the management of TB-HIV patients. The highest HCI score may serve as a benchmark to assess TB-HIV management, encouraging continuous health care improvement. © 2013 The Union.