title: Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina.
abstract: OBJECTIVE
  Tuberculosis (TB) is a leading cause of death in HIV-infected patients worldwide. We aimed to study clinical characteristics and outcome of 1075 consecutive patients diagnosed with HIV/TB from 2004 to 2006 in Europe and Argentina.
  
  
  METHODS
  One-year mortality was assessed in patients stratified according to region of residence, and factors associated with death were evaluated in multivariable Cox models.
  
  
  RESULTS
  At TB diagnosis, patients in Eastern Europe had less advanced immunodeficiency, whereas a greater proportion had a history of intravenous drug use, coinfection with hepatitis C, disseminated TB, and infection with drug-resistant TB (P < 0.0001). In Eastern Europe, fewer patients initiated TB treatment containing at least rifamycin, isoniazid, and pyrazinamide or combination antiretroviral therapy (P < 0.0001). Mortality at 1 year was 27% in Eastern Europe, compared with 7, 9 and 11% in Central/Northern Europe, Southern Europe, and Argentina, respectively (P < 0.0001). In a multivariable model, the adjusted relative hazard of death was significantly lower in each of the other regions compared with Eastern Europe: 0.34 (95% confidence interval 0.17-0.65), 0.28 (0.14-0.57), 0.34 (0.15-0.77) in Argentina, Southern Europe and Central/Northern Europe, respectively. Factors significantly associated with increased mortality were CD4 cell count less than 200 cells/microl [2.31 (1.56-3.45)], prior AIDS [1.74 (1.22-2.47)], disseminated TB [2.00 (1.38-2.85)], initiation of TB treatment not including rifamycin, isoniazid and pyrazinamide [1.68 (1.20-2.36)], and rifamycin resistance [2.10 (1.29-3.41)]. Adjusting for these known confounders did not explain the increased mortality seen in Eastern Europe.
  
  
  CONCLUSIONS
  The poor outcome of patients with HIV/TB in Eastern Europe deserves further study and urgent public health attention.
authors.affiliation: University of Copenhagen, Copenhagen HIV Programme, The Panum Institute/Building 21.1, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. dpo@cphiv.dk
authors.forename: Daria N
authors.initials: DN
authors.lastname: Podlekareva
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Frank A
authors.initials: FA
authors.lastname: Post
authors.forename: Vija
authors.initials: V
authors.lastname: Riekstina
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.forename: Mathias
authors.initials: M
authors.lastname: Bruyand
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Panteleev
authors.forename: Aza G
authors.initials: AG
authors.lastname: Rakhmanova
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.forename: Marcello H
authors.initials: MH
authors.lastname: Losso
authors.forename: Javier J
authors.initials: JJ
authors.lastname: Toibaro
authors.forename: Joan
authors.initials: J
authors.lastname: Caylá
authors.forename: Rob F
authors.initials: RF
authors.lastname: Miller
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
authors.forename: Alena
authors.initials: A
authors.lastname: Skrahina
authors.forename: Nelly
authors.initials: N
authors.lastname: Chentsova
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
mesh_terms: D000328:Adult; D001118:Argentina / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D008297:Male; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*