TB/HIV mortality alarmingly high in eastern Europe

By David Douglas

Patients in eastern Europe with HIV and tuberculosis coinfection have a risk of death more than three times higher than their counterparts in western Europe and Latin America, according to an international group of researchers.

As Dr. Daria N. Podlekareva told Reuters Health by email, "Results of our study document that mortality among TB/HIV coinfected patients in eastern Europe is alarmingly high. We couldn't fully explain this high mortality rate by clinical and demographic characteristics, which are otherwise known to play an important role in patients' outcomes."

"There are other social and health care factors that are difficult to measure, but which significantly influence patients' survival. We hope that the results of our study will have clinical as well as public health implications and attract attention of healthcare authorities," she said.

In a February 1 online paper in the Lancet HIV, Dr. Podlekareva, of the University of Copenhagen, Denmark, and colleagues say they came to this conclusion after prospectively following more than 1,400 HIV patients at 62 centers in Europe and Latin America.

The primary endpoint of death within 12 months after starting TB treatment occurred in 264 patients (19%). Of these deaths, 188 (71%) were TB-related. The probability of all-cause death was 29% in eastern Europe, 4% in western Europe, and 11% in Latin America. For TB-related death the corresponding proportions were 23%, 1% and 4%. After adjustment, patients receiving care outside of eastern Europe had a 77% decreased risk of death.

In eastern Europe, compared to patients who started with at least three active anti-TB drugs, those who started with fewer were at higher risk of TB-related death (adjusted hazard ratio 3.17). This was also true of those who did not have baseline drug-susceptibility tests (aHR 2.24).

Only 18% of the eastern European patients were receiving antiretroviral therapy at TB diagnosis compared with 44% in western Europe and 39% in Latin America. At 12 months, the corresponding proportions were 67%, 92% and 85%.

Given these findings, Dr. Podlekareva concluded, "There is an urgent need to improve the health care approach for management of TB/HIV coinfected patients in eastern Europe by integrating care, ensuring availability of drugs and diagnostic tests, in particular drug-susceptibility tests for TB, and providing social support and opiate substitution therapy for those in need. We should also remember that eastern Europe is a heterogeneous region and the situation varies from country to country."

Commenting on the findings by email, Dr. Jennifer Furin, coauthor of an accompanying editorial, told Reuters Health that the study "is yet another example of a global TB problem that is out of control. The fact that one out of every three people with HIV in eastern Europe who is diagnosed with TB is dead within a year is alarming."

Dr. Furin, of Harvard Medical School, Boston, pointed out, "Once again, much of this is due to drug resistance and lack of good HIV care. Why this garners so little attention is puzzling and worrisome, since drug-resistant forms of TB will be one of the top killers of adults around the world if we do not act urgently to stop it today."

The European Union Seventh Framework Program funded this research. Three coauthors reported disclosures.

SOURCE: http://bit.ly/205zO3k and http://bit.ly/1Posi0y

Lancet HIV 2016.

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