Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality-a multicentre prospective cohort study.
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
06 Oct 2021
06 Oct 2021
Historique:
received:
13
04
2021
accepted:
20
08
2021
entrez:
7
10
2021
pubmed:
8
10
2021
medline:
9
10
2021
Statut:
epublish
Résumé
Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). 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. 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 naïve (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). 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 naïve, 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.
Sections du résumé
BACKGROUND
BACKGROUND
Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH).
METHODS
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
RESULTS
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 naïve (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
CONCLUSIONS
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 naïve, 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.
Identifiants
pubmed: 34615474
doi: 10.1186/s12879-021-06745-w
pii: 10.1186/s12879-021-06745-w
pmc: PMC8496077
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1038Subventions
Organisme : Medical Research Council
ID : MR/T001127/1
Pays : United Kingdom
Investigateurs
A Vassilenko
(A)
D Klimuk
(D)
O Kondratenko
(O)
A Zalutskaya
(A)
V Bondarenko
(V)
V Mitsura
(V)
E Kozorez
(E)
O Tumash
(O)
O Suetnov
(O)
D Paduto
(D)
V Iljina
(V)
T Kummik
(T)
K Mshvidobadze
(K)
N Lanchava
(N)
L Goginashvili
(L)
L Mikiashvili
(L)
N Bablishvili
(N)
B Rozentale
(B)
I Zeltina
(I)
I Janushkevich
(I)
I Caplinskiene
(I)
S Caplinskas
(S)
Z Kancauskiene
(Z)
A Wiercinska-Drapalo
(A)
M Thompson
(M)
J Kozlowska
(J)
A Grezesczuk
(A)
M Bura
(M)
B Knysz
(B)
M Inglot
(M)
A Garlicki
(A)
J Loster
(J)
D D Uiculescu
(DD)
A Rakhmanova
(A)
O Panteleev
(O)
A Yakovlev
(A)
A Kozlov
(A)
A Tyukalova
(A)
Y Vlasova
(Y)
T T Rofimov
(TT)
G Kyselyova
(G)
N Obel
(N)
J Gerstoft
(J)
G Kronborg
(G)
M C Payen
(MC)
K K Abeya
(KK)
C Necsoi
(C)
F Dabis
(F)
A Tsaranazy
(A)
C Cazanave
(C)
H Furrer
(H)
M Sagette
(M)
M Rickenbach
(M)
D Sculier
(D)
A Calmy
(A)
M Cavassini
(M)
A Bruno
(A)
E Bernasconi
(E)
M Hoffmann
(M)
P Vernazza
(P)
J Fehr
(J)
R Weber
(R)
R Miller
(R)
N Vora
(N)
G Cooke
(G)
S Mullaney
(S)
E Wilkins
(E)
V George
(V)
P Collini
(P)
D Dockrell
(D)
F Post
(F)
L Campbell
(L)
R Brum
(R)
E Mabonga
(E)
P Saigal
(P)
S Kegg
(S)
J Ainsworth
(J)
A Waters
(A)
J Dhar
(J)
K Ellis
(K)
E Girardi
(E)
A Rianda
(A)
V Galati
(V)
C Pinnetti
(C)
C Tommasi
(C)
G Lapadula
(G)
A Di Biagio
(A)
A Parisini
(A)
S Carbonara
(S)
G Angarano
(G)
M Purgatorio
(M)
A Matteelli
(A)
A Apostoli
(A)
J M Miro
(JM)
C Manzardo
(C)
C Ligero
(C)
J Gonzalez
(J)
Jose A Martinez-Martinez
(JA)
F Sanchez
(F)
H Knobel
(H)
M Salvadó
(M)
J L Lopez-Colomes
(JL)
X Martínez-Lacasa
(X)
E Cuchí
(E)
V Falcó
(V)
A Curran
(A)
M T Tortola
(MT)
I Ocaña
(I)
R Vidal
(R)
M A Sambeat
(MA)
V Pomar
(V)
P Coll
(P)
D Pozamczer
(D)
M Saumoy
(M)
F Alcaide
(F)
J Caylà
(J)
A Moreno
(A)
J P Millet
(JP)
A Orcau
(A)
L Fina
(L)
A Romero
(A)
L L Roldan
(LL)
J A Iribarren
(JA)
M Ibarguren
(M)
S Moreno
(S)
A González
(A)
P Miralles
(P)
T Aldámiz-Echevarría
(T)
M Losso
(M)
J Toibaro
(J)
L Gambardella
(L)
J Toibaro
(J)
L Moreno Macias
(L)
E Warley
(E)
S Tavella
(S)
O Garcia Messina
(O)
O Gear
(O)
H Laplume
(H)
C Marson
(C)
J Contarelia
(J)
M Michaan
(M)
P Scapellato
(P)
B Bartoletti
(B)
D Palmero
(D)
C Elias
(C)
C Cortes
(C)
B Crabtree
(B)
J L Mosqueda Gomez
(JL)
J A Villanueva
(JA)
L A Gonzalez Hernandez
(LA)
F Badial
(F)
Informations de copyright
© 2021. The Author(s).
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