title: Short- and long-term mortality and causes of death in HIV/tuberculosis patients in Europe.
abstract: 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.
authors.affiliation: University of Copenhagen, Copenhagen.
authors.forename: Daria N
authors.initials: DN
authors.lastname: Podlekareva
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Panteleev
authors.forename: Daniel
authors.initials: D
authors.lastname: Grint
authors.forename: Frank A
authors.initials: FA
authors.lastname: Post
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.forename: Mathias
authors.initials: M
authors.lastname: Bruyand
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.forename: Anna
authors.initials: A
authors.lastname: Vasilenko
authors.forename: Marcelo H
authors.initials: MH
authors.lastname: Losso
authors.forename: Alejandro
authors.initials: A
authors.lastname: Arenas-Pinto
authors.forename: Joan
authors.initials: J
authors.lastname: Caylá
authors.forename: Aza
authors.initials: A
authors.lastname: Rakhmanova
authors.forename: Indra
authors.initials: I
authors.lastname: Zeltina
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Werlinrud
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001118:Argentina; D002423:Cause of Death; D015331:Cohort Studies; D060085:Coinfection / Q000401:mortality*; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000401:mortality*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents