Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina

Podlekareva, Daria; Mocroft, Amanda; Post, FA; Riekstina,; Jm, Miró; Furrer, Hansjakob; Bruyand, Mathias; Am, Panteleev; Ag, Rakhmanova; Girardi, Enrico; Losso, Marcelo; Toibaro, J; Caylà, Joan A.; Miller, R F; Obel, Niels; Skrahina, Alena; Chentsova, N; Lundgren, Jens D.; Kirk, Ole; Hiv,

doi:10.1097/qad.0b013e3283326879

Cited by 37 publications

(26 citation statements)

References 15 publications

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“…During the first year following TB diagnosis, mortality was the highest within the first 3 months, being invasive bacterial infection the major cause of death. The 13% mortality within the first year after TB diagnosis found in our cohort is higher than the mortality reported in Argentina but much lower than the mortality described in Eastern Europe [22, 23] and Sub-Saharan Africa [24]. Of note, our patients received highly qualified HIV services including integrated HIV-1/TB care, universal access to cART, opportunistic infections diagnosis and treatment and intensive care management.…”

Section: Discussioncontrasting

confidence: 51%

Mortality in patients with HIV-1 and tuberculosis co-infection in Rio de Janeiro, Brazil - associated factors and causes of death

et al. 2017

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BackgroundTuberculosis is the most frequent opportunistic infection and the leading cause of death among persons living with HIV in several low and middle-income countries. Mortality rates during tuberculosis treatment and death causes among HIV-1/TB co-infected patients may differ based on the immunosuppression severity, timing of diagnosis and prompt initiation of tuberculosis and antiretroviral therapy.MethodsThis was a retrospective observational study conducted in the clinical cohort of patients with HIV-1/Aids of the National Institute of Infectious Diseases Evandro Chagas, Rio de Janeiro, Brazil. All HIV-1 infected patients who started combination antiretroviral therapy up to 30 days before or within 180 days after the start of tuberculosis treatment from 2000 to 2010 were eligible. Causes of death were categorized according to the "Coding Causes of Death in HIV” (CoDe) protocol. The Cox model was used to estimate the hazard ratio (HR) of selected mortality variables.ResultsA total of 310 patients were included. Sixty-four patients died during the study period. Mortality rate following tuberculosis treatment initiation was 44 per 100 person-years within the first 30 days, 28.1 per 100 person-years within 31 and 90 days, 6 per 100 person-years within 91 and 365 days and 1.6 per 100 person-years after 365 days. Death probability within one year from tuberculosis treatment initiation was approximately 13%. In the adjusted analysis the associated factors with mortality were: CD4 ≤ 50 cells/mm3 (HR: 3.10; 95% CI: 1.720 to 5.580; p = 0.00); mechanical ventilation (HR: 2.81; 95% CI: 1.170 to 6.760; p = 0.02); and disseminated tuberculosis (HR: 3.70; 95% CI: 1.290 to 10.590, p = 0.01). Invasive bacterial disease was the main immediate cause of death (46.9%).ConclusionOur results evidence the high morbidity and mortality among patients co-infected with HIV-1 and tuberculosis in Rio de Janeiro, Brazil. During the first year following tuberculosis diagnosis, mortality was the highest within the first 3 months, being invasive bacterial infection the major cause of death. In order to successfully intervene in this scenario, it is utterly necessary to address the social determinants of health contributing to the inequitable health care access faced by this population.

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Section: Discussioncontrasting

confidence: 51%

Mortality in patients with HIV-1 and tuberculosis co-infection in Rio de Janeiro, Brazil - associated factors and causes of death

et al. 2017

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“…However, we relied on self-reports of adherence for only a 2-day period, and self-report data can reflect an underreporting of socially undesirable responses. Access to HAART in Russia has been challenged by an insufficient HAART treatment service infrastructure with limited capacity to manage adverse treatment effects [32] and co-infections [33], and less opportunity for IDUs to receive HAART [1]. Additional studies need to employ more comprehensive methods to evaluate HAART treatment adherence and to identify reasons for treatment refusal.…”

Section: Discussionmentioning

confidence: 99%

People with HIV in HAART-Era Russia: Transmission Risk Behavior Prevalence, Antiretroviral Medication-Taking, and Psychosocial Distress

et al. 2010

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Russia has seen one of the world’s fastest-growing HIV epidemics. Transmission risk behavior, HAART-taking, and psychosocial distress of the growing population of Russian people living with HIV (PLH) in the HAART era are understudied. Participants of a systematically-recruited cross-sectional sample of 492 PLH in St. Petersburg completed measures of sexual and drug injection practices, adherence, perceived discrimination, and psychosocial distress. Since learning of their status, 59% of participants had partners of HIV-negative or unknown serostatus (mean=5.9). 52% reported unprotected intercourse with such partners, with 29% of acts unprotected. Greater perceived discrimination predicted lower condom use. 23% of IDU PLH still shared needles, predicted by having no primary partner, lower education, and more frequently-encountered discrimination. 25% of PLH had been refused general health care, 11% refused employment, 6% fired, and 6% forced from family homes. 39% of participants had probable clinical depression, 37% had anxiety levels comparable to psychiatric inpatients, and social support was low. 54% of PLH were on HAART, 16% of PLH refused HAART regimens, and 5% took less than 90% of their doses. Comprehensive community services for Russian PLH are needed to reduce AIDS-related psychosocial distress and continued HIV transmission risk behaviors. Social programs should reduce stigma and discrimination, and promote social integration of affected persons and their families.

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“…Incidence of tuberculosis has fallen or stabilised in IDUs in many developed countries during the past three decades—possibly as a result of earlier case detection, attention to infection control, and isoniazid preventive treatment—but not in eastern Europe or countries of the former Soviet Union. 67 Moreover, in many of the most populous countries of Asia, injecting drug use contributes greatly to expanding HIV epidemics and high rates of tuberculosis.…”

Section: Comorbidities and Their Treatmentsmentioning

confidence: 99%

“…67,147,162 Nevertheless, since HIV-infected drug users have such a high risk of imprisonment, these congregate settings are important for diagnosis, treatment, and implementation of adherence interventions. When appropriately organised, time-restricted treatment for tuberculosis 163 and HCV infection 164 has been effectively implemented within prisons.…”

Section: The Criminal Justice System and Hiv-related Comorbiditymentioning

confidence: 99%

Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs

Altice

Kamarulzaman

Soriano³

et al. 2010

The Lancet

443

428

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HIV-infected drug users have increased age-matched morbidity and mortality compared with HIV-infected people who do not use drugs. Substance-use disorders negatively affect the health of HIV-infected drug users, who also have frequent medical and psychiatric comorbidities that complicate HIV treatment and prevention. Evidence-based treatments are available for the management of substance-use disorders, mental illness, HIV and other infectious complications such as viral hepatitis and tuberculosis, and many non-HIV-associated comorbidities. Tuberculosis co-infection in HIV-infected drug users, including disease caused by drug-resistant strains, is acquired and transmitted as a consequence of inadequate prescription of antiretroviral therapy, poor adherence, and repeated interfaces with congregate settings such as prisons. Medication-assisted therapies provide the strongest evidence for HIV treatment and prevention efforts, yet are often not available where they are needed most. Antiretroviral therapy, when prescribed and adherence is at an optimum, improves health-related outcomes for HIV infection and many of its comorbidities, including tuberculosis, viral hepatitis, and renal and cardiovascular disease. Simultaneous clinical management of multiple comorbidities in HIV-infected drug users might result in complex pharmacokinetic drug interactions that must be adequately addressed. Moreover, interventions to improve adherence to treatment, including integration of health services delivery, are needed. Multifaceted, interdisciplinary approaches are urgently needed to achieve parity in health outcomes in HIV-infected drug users.

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Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina

Abstract: The poor outcome of patients with HIV/TB in Eastern Europe deserves further study and urgent public health attention.

Cited by 37 publications

References 15 publications

Mortality in patients with HIV-1 and tuberculosis co-infection in Rio de Janeiro, Brazil - associated factors and causes of death

Mortality in patients with HIV-1 and tuberculosis co-infection in Rio de Janeiro, Brazil - associated factors and causes of death

People with HIV in HAART-Era Russia: Transmission Risk Behavior Prevalence, Antiretroviral Medication-Taking, and Psychosocial Distress

Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs

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