title: Impact of HIV infection on treatment outcome of tuberculosis in Europe.
abstract: BACKGROUND
  The effect of HIV on tuberculosis (TB) treatment outcomes has not been well established. We aimed to assess the impact of HIV infection on TB treatment outcomes by using data from notifiable disease surveillance in Europe.
  
  
  METHODS
  We analyzed the treatment outcomes of TB cases reported from nine European countries during 2010-2012. We investigate the effect of HIV on TB treatment outcomes using a multilevel and a multinomial logistic model, and considering the interaction between HIV and multidrug-resistant (MDR) TB.
  
  
  RESULTS
  A total of 61,138 TB cases including 5.5% HIV-positive were eligible for our analysis. In the multilevel model adjusted for age and an interaction with MDR TB, HIV was significantly associated with lower treatment success in all MDR strata [non-MDR TB: odds ratio (OR) 0.24 CI (confidence interval) 0.20-0.29; unknown MDR TB status: OR 0.26 CI 0.23-0.30; MDR TB: OR 0.57 CI 0.35-0.91]. In the multinomial regression model, HIV-positive cases had significantly higher relative risk ratio (RRR) for death (non-MDR TB: RRR 4.30 CI 2.31-7.99; unknown MDR TB status: 5.55 CI 3.10-9.92; MDR TB: 3.59 CI 1.56-8.28) and being 'still on treatment' (non-MDR TB: RRR 7.27 CI 3.00-17.6; unknown MDR TB status: 5.36 CI 2.44-11.8; MDR TB: 3.76 CI 2.48-5.71). We did not find any significant association between HIV and TB treatment failure (non-MDR TB: RRR 0.50 CI 0.15-1.67; unknown MDR TB status: 1.51 CI 0.86-2.64; MDR TB: 0.51 CI 0.13-1.87).
  
  
  CONCLUSIONS
  This large study confirms that HIV is a strong risk factor for an adverse TB treatment outcome, which is mainly manifested by an increased risk of death and still being on TB treatment.
authors.affiliation: aDepartment for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin bPhD Programme 'Epidemiology', Braunschweig-Hannover cDepartment of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig dHannover Medical School (MHH), Hannover, Germany eEuropean Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: Basel
authors.initials: B
authors.lastname: Karo
authors.forename: Gérard
authors.initials: G
authors.lastname: Krause
authors.forename: Vahur
authors.initials: V
authors.lastname: Hollo
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: van der Werf
authors.forename: Stefanie
authors.initials: S
authors.lastname: Castell
authors.forename: Osamah
authors.initials: O
authors.lastname: Hamouda
authors.forename: Walter
authors.initials: W
authors.lastname: Haas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents