Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality-a multicentre prospective cohort study
Por:
Kraef, C, Bentzon, A, Panteleev, A, Skrahina, A, Bolokadze, N, Tetradov, S, Podlasin, R, Karpov, I, Borodulina, E, Denisova, E, Azina, I, Lundgren, J, Johansen, IS, Mocroft, A, Podlekareva, D, Kirk, O, Pomar V., Millet J.P., Orcau A., TB HIV Study Grp
Publicada:
6 oct 2021
Resumen:
Background Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for >= 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan-Meier estimates and Cox models. Findings 480/740 patients (64.9%; 95% CI 61.3-68.3%) experienced a delayed diagnosis. Age >= 50 years (vs. < 50 years, aOR = 2.51; 1.18-5.32; p = 0.016), injecting drug use (IDU) (vs. non-IDU aOR = 1.66; 1.21-2.29; p = 0.002), being ART naive (aOR = 1.77; 1.24-2.54; p = 0.002), disseminated TB (vs. pulmonary TB, aOR = 1.56, 1.10-2.19, p = 0.012), and presenting with weight loss (vs. no weight loss, aOR = 1.63; 1.18-2.24; p = 0.003) were associated with delayed diagnosis. PLWH with a delayed diagnosis were at 36% increased risk of death (hazard ratio = 1.36; 1.04-1.77; p = 0.023, adjusted hazard ratio 1.27; 0.95-1.70; p = 0.103). Conclusion Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naive, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe.
Filiaciones:
Kraef, C:
Univ Copenhagen, Rigshosp, CHIP Ctr Excellence Hlth Immun & Infect, Copenhagen, Denmark
Univ Copenhagen, Rigshosp, Heart Ctr, Dept Infect Dis, Copenhagen, Denmark
Heidelberg Univ, Heidelberg Inst Global Hlth, Heidelberg, Germany
Bentzon, A:
Univ Copenhagen, Rigshosp, CHIP Ctr Excellence Hlth Immun & Infect, Copenhagen, Denmark
Panteleev, A:
City TB Dispensary, St Petersburg, Russia
Skrahina, A:
Republican Sci & Pract Ctr Pulmonol & TB, Minsk, BELARUS
Bolokadze, N:
Infect Dis AIDS & Clin Immunol Res Ctr, Tbilisi, Georgia
Tetradov, S:
Dr Victor Babes Hosp Trop & Infect Dis, Bucharest, Romania
Carol Davila Univ Med & Pharm, Bucharest, Romania
Podlasin, R:
Med Univ Warsaw, Wojewodski Szpital Zakanzy, Warsaw, Poland
Karpov, I:
Belarusian State Med Univ, Dept Infect Dis, Minsk, BELARUS
Borodulina, E:
Samara State Med Univ, Minist Healthcare Russian Federat, Samara, Russia
Denisova, E:
Botkin Hosp Infect Dis, St Petersburg, Russia
Azina, I:
Riga East Univ Hosp, Latvian Ctr Infect Dis, Riga, Latvia
Lundgren, J:
Univ Copenhagen, Rigshosp, CHIP Ctr Excellence Hlth Immun & Infect, Copenhagen, Denmark
Johansen, IS:
Univ Southern, Odense Univ Hosp, Res Unit Infect Dis, Odense, Denmark
Mocroft, A:
Univ Copenhagen, Rigshosp, CHIP Ctr Excellence Hlth Immun & Infect, Copenhagen, Denmark
UCL, Inst Global Hlth, Ctr Clin Res Epidemiol Modelling & Evaluat CREME, London, England
Podlekareva, D:
Univ Copenhagen, Rigshosp, CHIP Ctr Excellence Hlth Immun & Infect, Copenhagen, Denmark
Kirk, O:
Univ Copenhagen, Rigshosp, CHIP Ctr Excellence Hlth Immun & Infect, Copenhagen, Denmark
Univ Copenhagen, Rigshosp, Heart Ctr, Dept Infect Dis, Copenhagen, Denmark
Univ Southern, Odense Univ Hosp, Res Unit Infect Dis, Odense, Denmark
Pomar V.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Millet J.P.:
Agència de Salut Pública de Barcelona, Barcelona, Spain
Orcau A.:
Agència de Salut Pública de Barcelona, Barcelona, Spain
gold, Green Published
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