Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe :: associated factors and effect on mortality-a multicentre prospective cohort study

Vicenç Falcó; Virginia Pomar; Christian Kraef; Adrian Bentzon; Alexander Panteleev; Alena Skrahina; Natalie Bolokadze; Simona Tetradov; Regina Podlasin; Igor Karpov; Elena Borodulina; Elena Denisova; Inga Azina; Jens Lundgren; Isik Somuncu Johansen; Amanda Mocroft; Daria Podlekareva; Ole Kirk; A. Vassilenko; D. Klimuk; O. Kondratenko; A. Zalutskaya; V. Bondarenko; V. Mitsura; E. Kozorez; O. Tumash; O. Suetnov; D. Paduto; V. Iljina; T. Kummik; K. Mshvidobadze; N. Lanchava; L. Goginashvili; L. Mikiashvili; Nino Bablishvili; B. Rozentale; I. Zeltina; I. Janushkevich; I. Caplinskiene; S. Caplinskas; Z. Kancauskiene; A. Wiercinska-Drapalo; M. Thompson; J. Kozlowska; A. Grezesczuk; M. Bura; B. Knysz; M. Inglot; A. Garlicki; J. Loster; D.D. uiculescu; A. Rakhmanova; O. Panteleev; A. Yakovlev; A. Kozlov; A. Tyukalova; Y. Vlasova; T.T. rofimov; G. Kyselyova; N. Obel; J. Gerstoft; G. Kronborg; M.C. Payen; K.K. abeya; C. Necsoi; F. Dabis; A. Tsaranazy; C. Cazanave; H. Furrer; M. Sagette; M. Rickenbach; D. Sculier; A. Calmy; Matthias Cavassini; A. Bruno; E. Bernasconi; M. Hoffmann; P. Vernazza; J. Fehr; R. Weber; R. Miller; N. Vora; G. Cooke; S. Mullaney; E. Wilkins; V. George; P. Collini; D. Dockrell; F. Post; L. Campbell; R. Brum; E. Mabonga; P. Saigal; S. Kegg; J. Ainsworth; A. Waters; J. Dhar; K. Ellis; E. Girardi; A. Rianda; V. Galati; C. Pinnetti; C. Tommasi; G. Lapadula; A. Di Biagio; A. Parisini; S. Carbonara; G. Angarano; M. Purgatorio; A. Matteelli; A. Apostoli; J.M. Miro; C. Manzardo; C. Ligero; J. Gonzalez; J.A. Martinez-Martinez; F. Sanchez; Hernando Knobel Freud; M. Salvadó; J.L. Lopez-Colomes; X. Martínez-Lacasa; E. Cuchí; Adrian Curran; M.T. Tortola; Immaculada Ocaña Rivera; R. Vidal; M.A. Sambeat; P. Coll; D. Pozamczer; M. Saumoy; Fernando Alcaide; Joan A Caylà; Asunción Moreno Camacho; Joan-Pau Millet; Àngels Orcau; L. Fina; A. Romero; L.L. Roldan; J.A. Iribarren; M. Ibarguren; S. Moreno; A. González; P. Miralles; T. Aldámiz-Echevarría; M. Losso; J. Toibaro; L. Gambardella; J. Toibaro; L. Moreno Macias; E. Warley; S. Tavella; O. Garcia Messina; O. Gear; H. Laplume; C. Marson; J. Contarelia; M. Michaan; P. Scapellato; B. Bartoletti; D. Palmero; C. Elias; C. Cortes; B. Crabtree; J.L. Mosqueda Gomez; J.A. Villanueva; L.A. Gonzalez Hernandez; F. Badial

doi:10.1186/s12879-021-06745-w

Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe : associated factors and effect on mortality-a multicentre prospective cohort study

Vicenç Falcó, Virginia Pomar, Christian Kraef, Adrian Bentzon, Alexander Panteleev, Alena Skrahina, Natalie Bolokadze, Simona Tetradov, Regina Podlasin, Igor Karpov, Elena Borodulina, Elena Denisova, Inga Azina, Jens Lundgren, Isik Somuncu Johansen, Amanda Mocroft, Daria Podlekareva, Ole Kirk, A. Vassilenko, D. KlimukO. Kondratenko, A. Zalutskaya, V. Bondarenko, V. Mitsura, E. Kozorez, O. Tumash, O. Suetnov, D. Paduto, V. Iljina, T. Kummik, K. Mshvidobadze, N. Lanchava, L. Goginashvili, L. Mikiashvili, Nino Bablishvili, B. Rozentale, I. Zeltina, I. Janushkevich, I. Caplinskiene, S. Caplinskas, Z. Kancauskiene, A. Wiercinska-Drapalo, M. Thompson, J. Kozlowska, A. Grezesczuk, M. Bura, B. Knysz, M. Inglot, A. Garlicki, J. Loster, D.D. uiculescu, A. Rakhmanova, O. Panteleev, A. Yakovlev, A. Kozlov, A. Tyukalova, Y. Vlasova, T.T. rofimov, G. Kyselyova, N. Obel, J. Gerstoft, G. Kronborg, M.C. Payen, K.K. abeya, C. Necsoi, F. Dabis, A. Tsaranazy, C. Cazanave, H. Furrer, M. Sagette, M. Rickenbach, D. Sculier, A. Calmy, Matthias Cavassini, A. Bruno, E. Bernasconi, M. Hoffmann, P. Vernazza, J. Fehr, R. Weber, R. Miller, N. Vora, G. Cooke, S. Mullaney, E. Wilkins, V. George, P. Collini, D. Dockrell, F. Post, L. Campbell, R. Brum, E. Mabonga, P. Saigal, S. Kegg, J. Ainsworth, A. Waters, J. Dhar, K. Ellis, E. Girardi, A. Rianda, V. Galati, C. Pinnetti, C. Tommasi, G. Lapadula, A. Di Biagio, A. Parisini, S. Carbonara, G. Angarano, M. Purgatorio, A. Matteelli, A. Apostoli, J.M. Miro, C. Manzardo, C. Ligero, J. Gonzalez, J.A. Martinez-Martinez, F. Sanchez, Hernando Knobel Freud, M. Salvadó, J.L. Lopez-Colomes, X. Martínez-Lacasa, E. Cuchí, Adrian Curran, M.T. Tortola, Immaculada Ocaña Rivera, R. Vidal, M.A. Sambeat, P. Coll, D. Pozamczer, M. Saumoy, Fernando Alcaide, Joan A Caylà, Asunción Moreno Camacho, Joan-Pau Millet, Àngels Orcau, L. Fina, A. Romero, L.L. Roldan, J.A. Iribarren, M. Ibarguren, S. Moreno, A. González, P. Miralles, T. Aldámiz-Echevarría, M. Losso, J. Toibaro, L. Gambardella, J. Toibaro, L. Moreno Macias, E. Warley, S. Tavella, O. Garcia Messina, O. Gear, H. Laplume, C. Marson, J. Contarelia, M. Michaan, P. Scapellato, B. Bartoletti, D. Palmero, C. Elias, C. Cortes, B. Crabtree, J.L. Mosqueda Gomez, J.A. Villanueva, L.A. Gonzalez Hernandez, F. Badial

Department of Medicine

CIS - Centro de Investigación Sociológica

Research output: Contribution to journal › Article › Research › peer-review

15 Citations (Scopus)

Abstract

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 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: 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.

Original language	English
Journal	BMC Infectious Diseases
Volume	21
Issue number	1
DOIs	https://doi.org/10.1186/s12879-021-06745-w
Publication status	Published - 2021

Keywords

Aged
Delayed Diagnosis
Europe, Eastern
HIV Infections
Humans
Middle Aged
Prospective Studies
Tuberculosis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s12879-021-06745-w

https://ddd.uab.cat/record/270248

Cite this

Falcó, V., Pomar, V., 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, I. S., Mocroft, A., Podlekareva, D., Kirk, O., Vassilenko, A., ... Badial, F. (2021). Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe : associated factors and effect on mortality-a multicentre prospective cohort study. BMC Infectious Diseases, 21(1). https://doi.org/10.1186/s12879-021-06745-w

@article{ec5d1c408ee641e78ebaf82dc8776072,

title = "Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe :: associated factors and effect on mortality-a multicentre prospective cohort study",

abstract = "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 na{\"i}ve (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 na{\"i}ve, 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.",

keywords = "Aged, Delayed Diagnosis, Europe, Eastern, HIV Infections, Humans, Middle Aged, Prospective Studies, Tuberculosis",

author = "Vicen{\c c} Falc{\'o} and Virginia Pomar and Christian Kraef and Adrian Bentzon and Alexander Panteleev and Alena Skrahina and Natalie Bolokadze and Simona Tetradov and Regina Podlasin and Igor Karpov and Elena Borodulina and Elena Denisova and Inga Azina and Jens Lundgren and Johansen, {Isik Somuncu} and Amanda Mocroft and Daria Podlekareva and Ole Kirk and A. Vassilenko and D. Klimuk and O. Kondratenko and A. Zalutskaya and V. Bondarenko and V. Mitsura and E. Kozorez and O. Tumash and O. Suetnov and D. Paduto and V. Iljina and T. Kummik and K. Mshvidobadze and N. Lanchava and L. Goginashvili and L. Mikiashvili and Nino Bablishvili and B. Rozentale and I. Zeltina and I. Janushkevich and I. Caplinskiene and S. Caplinskas and Z. Kancauskiene and A. Wiercinska-Drapalo and M. Thompson and J. Kozlowska and A. Grezesczuk and M. Bura and B. Knysz and M. Inglot and A. Garlicki and J. Loster and D.D. uiculescu and A. Rakhmanova and O. Panteleev and A. Yakovlev and A. Kozlov and A. Tyukalova and Y. Vlasova and T.T. rofimov and G. Kyselyova and N. Obel and J. Gerstoft and G. Kronborg and M.C. Payen and K.K. abeya and C. Necsoi and F. Dabis and A. Tsaranazy and C. Cazanave and H. Furrer and M. Sagette and M. Rickenbach and D. Sculier and A. Calmy and Matthias Cavassini and A. Bruno and E. Bernasconi and M. Hoffmann and P. Vernazza and J. Fehr and R. Weber and R. Miller and N. Vora and G. Cooke and S. Mullaney and E. Wilkins and V. George and P. Collini and D. Dockrell and F. Post and L. Campbell and R. Brum and E. Mabonga and P. Saigal and S. Kegg and J. Ainsworth and A. Waters and J. Dhar and K. Ellis and E. Girardi and A. Rianda and V. Galati and C. Pinnetti and C. Tommasi and G. Lapadula and {Di Biagio}, A. and A. Parisini and S. Carbonara and G. Angarano and M. Purgatorio and A. Matteelli and A. Apostoli and J.M. Miro and C. Manzardo and C. Ligero and J. Gonzalez and J.A. Martinez-Martinez and F. Sanchez and {Knobel Freud}, Hernando and M. Salvad{\'o} and J.L. Lopez-Colomes and X. Mart{\'i}nez-Lacasa and E. Cuch{\'i} and Adrian Curran and M.T. Tortola and {Oca{\~n}a Rivera}, Immaculada and R. Vidal and M.A. Sambeat and P. Coll and D. Pozamczer and M. Saumoy and Fernando Alcaide and Cayl{\`a}, {Joan A} and {Moreno Camacho}, Asunci{\'o}n and Joan-Pau Millet and {\`A}ngels Orcau and L. Fina and A. Romero and L.L. Roldan and J.A. Iribarren and M. Ibarguren and S. Moreno and A. Gonz{\'a}lez and P. Miralles and T. Ald{\'a}miz-Echevarr{\'i}a and M. Losso and J. Toibaro and L. Gambardella and J. Toibaro and {Moreno Macias}, L. and E. Warley and S. Tavella and {Garcia Messina}, O. and O. Gear and H. Laplume and C. Marson and J. Contarelia and M. Michaan and P. Scapellato and B. Bartoletti and D. Palmero and C. Elias and C. Cortes and B. Crabtree and {Mosqueda Gomez}, J.L. and J.A. Villanueva and {Gonzalez Hernandez}, L.A. and F. Badial",

year = "2021",

doi = "10.1186/s12879-021-06745-w",

language = "English",

volume = "21",

number = "1",

}

Falcó, V , Pomar, V, 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, Vassilenko, A, Klimuk, D, Kondratenko, O, Zalutskaya, A, Bondarenko, V, Mitsura, V, Kozorez, E, Tumash, O, Suetnov, O, Paduto, D, Iljina, V, Kummik, T, Mshvidobadze, K, Lanchava, N, Goginashvili, L, Mikiashvili, L, Bablishvili, N, Rozentale, B, Zeltina, I, Janushkevich, I, Caplinskiene, I, Caplinskas, S, Kancauskiene, Z, Wiercinska-Drapalo, A, Thompson, M, Kozlowska, J, Grezesczuk, A, Bura, M, Knysz, B, Inglot, M, Garlicki, A, Loster, J, uiculescu, DD, Rakhmanova, A, Panteleev, O, Yakovlev, A, Kozlov, A, Tyukalova, A, Vlasova, Y, rofimov, TT, Kyselyova, G, Obel, N, Gerstoft, J, Kronborg, G, Payen, MC, abeya, KK, Necsoi, C, Dabis, F, Tsaranazy, A, Cazanave, C, Furrer, H, Sagette, M, Rickenbach, M, Sculier, D, Calmy, A, Cavassini, M, Bruno, A, Bernasconi, E, Hoffmann, M, Vernazza, P, Fehr, J, Weber, R, Miller, R, Vora, N, Cooke, G, Mullaney, S, Wilkins, E, George, V, Collini, P, Dockrell, D, Post, F, Campbell, L, Brum, R, Mabonga, E, Saigal, P, Kegg, S, Ainsworth, J, Waters, A, Dhar, J, Ellis, K, Girardi, E, Rianda, A, Galati, V, Pinnetti, C, Tommasi, C, Lapadula, G, Di Biagio, A, Parisini, A, Carbonara, S, Angarano, G, Purgatorio, M, Matteelli, A, Apostoli, A, Miro, JM, Manzardo, C, Ligero, C, Gonzalez, J, Martinez-Martinez, JA, Sanchez, F, Knobel Freud, H, Salvadó, M, Lopez-Colomes, JL, Martínez-Lacasa, X, Cuchí, E, Curran, A, Tortola, MT, Ocaña Rivera, I, Vidal, R, Sambeat, MA, Coll, P, Pozamczer, D, Saumoy, M, Alcaide, F, Caylà, JA, Moreno Camacho, A, Millet, J-P, Orcau, À, Fina, L, Romero, A, Roldan, LL, Iribarren, JA, Ibarguren, M, Moreno, S, González, A, Miralles, P, Aldámiz-Echevarría, T, Losso, M, Toibaro, J, Gambardella, L, Toibaro, J, Moreno Macias, L, Warley, E, Tavella, S, Garcia Messina, O, Gear, O, Laplume, H, Marson, C, Contarelia, J, Michaan, M, Scapellato, P, Bartoletti, B, Palmero, D, Elias, C, Cortes, C, Crabtree, B, Mosqueda Gomez, JL, Villanueva, JA, Gonzalez Hernandez, LA & Badial, F 2021, 'Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe : associated factors and effect on mortality-a multicentre prospective cohort study', BMC Infectious Diseases, vol. 21, no. 1. https://doi.org/10.1186/s12879-021-06745-w

TY - JOUR

T1 - Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe :

T2 - associated factors and effect on mortality-a multicentre prospective cohort study

AU - Falcó, Vicenç

AU - Pomar, Virginia

AU - Kraef, Christian

AU - Bentzon, Adrian

AU - Panteleev, Alexander

AU - Skrahina, Alena

AU - Bolokadze, Natalie

AU - Tetradov, Simona

AU - Podlasin, Regina

AU - Karpov, Igor

AU - Borodulina, Elena

AU - Denisova, Elena

AU - Azina, Inga

AU - Lundgren, Jens

AU - Johansen, Isik Somuncu

AU - Mocroft, Amanda

AU - Podlekareva, Daria

AU - Kirk, Ole

AU - Vassilenko, A.

AU - Klimuk, D.

AU - Kondratenko, O.

AU - Zalutskaya, A.

AU - Bondarenko, V.

AU - Mitsura, V.

AU - Kozorez, E.

AU - Tumash, O.

AU - Suetnov, O.

AU - Paduto, D.

AU - Iljina, V.

AU - Kummik, T.

AU - Mshvidobadze, K.

AU - Lanchava, N.

AU - Goginashvili, L.

AU - Mikiashvili, L.

AU - Bablishvili, Nino

AU - Rozentale, B.

AU - Zeltina, I.

AU - Janushkevich, I.

AU - Caplinskiene, I.

AU - Caplinskas, S.

AU - Kancauskiene, Z.

AU - Wiercinska-Drapalo, A.

AU - Thompson, M.

AU - Kozlowska, J.

AU - Grezesczuk, A.

AU - Bura, M.

AU - Knysz, B.

AU - Inglot, M.

AU - Garlicki, A.

AU - Loster, J.

AU - uiculescu, D.D.

AU - Rakhmanova, A.

AU - Panteleev, O.

AU - Yakovlev, A.

AU - Kozlov, A.

AU - Tyukalova, A.

AU - Vlasova, Y.

AU - rofimov, T.T.

AU - Kyselyova, G.

AU - Obel, N.

AU - Gerstoft, J.

AU - Kronborg, G.

AU - Payen, M.C.

AU - abeya, K.K.

AU - Necsoi, C.

AU - Dabis, F.

AU - Tsaranazy, A.

AU - Cazanave, C.

AU - Furrer, H.

AU - Sagette, M.

AU - Rickenbach, M.

AU - Sculier, D.

AU - Calmy, A.

AU - Cavassini, Matthias

AU - Bruno, A.

AU - Bernasconi, E.

AU - Hoffmann, M.

AU - Vernazza, P.

AU - Fehr, J.

AU - Weber, R.

AU - Miller, R.

AU - Vora, N.

AU - Cooke, G.

AU - Mullaney, S.

AU - Wilkins, E.

AU - George, V.

AU - Collini, P.

AU - Dockrell, D.

AU - Post, F.

AU - Campbell, L.

AU - Brum, R.

AU - Mabonga, E.

AU - Saigal, P.

AU - Kegg, S.

AU - Ainsworth, J.

AU - Waters, A.

AU - Dhar, J.

AU - Ellis, K.

AU - Girardi, E.

AU - Rianda, A.

AU - Galati, V.

AU - Pinnetti, C.

AU - Tommasi, C.

AU - Lapadula, G.

AU - Di Biagio, A.

AU - Parisini, A.

AU - Carbonara, S.

AU - Angarano, G.

AU - Purgatorio, M.

AU - Matteelli, A.

AU - Apostoli, A.

AU - Miro, J.M.

AU - Manzardo, C.

AU - Ligero, C.

AU - Gonzalez, J.

AU - Martinez-Martinez, J.A.

AU - Sanchez, F.

AU - Knobel Freud, Hernando

AU - Salvadó, M.

AU - Lopez-Colomes, J.L.

AU - Martínez-Lacasa, X.

AU - Cuchí, E.

AU - Curran, Adrian

AU - Tortola, M.T.

AU - Ocaña Rivera, Immaculada

AU - Vidal, R.

AU - Sambeat, M.A.

AU - Coll, P.

AU - Pozamczer, D.

AU - Saumoy, M.

AU - Alcaide, Fernando

AU - Caylà, Joan A

AU - Moreno Camacho, Asunción

AU - Millet, Joan-Pau

AU - Orcau, Àngels

AU - Fina, L.

AU - Romero, A.

AU - Roldan, L.L.

AU - Iribarren, J.A.

AU - Ibarguren, M.

AU - Moreno, S.

AU - González, A.

AU - Miralles, P.

AU - Aldámiz-Echevarría, T.

AU - Losso, M.

AU - Toibaro, J.

AU - Gambardella, L.

AU - Toibaro, J.

AU - Moreno Macias, L.

AU - Warley, E.

AU - Tavella, S.

AU - Garcia Messina, O.

AU - Gear, O.

AU - Laplume, H.

AU - Marson, C.

AU - Contarelia, J.

AU - Michaan, M.

AU - Scapellato, P.

AU - Bartoletti, B.

AU - Palmero, D.

AU - Elias, C.

AU - Cortes, C.

AU - Crabtree, B.

AU - Mosqueda Gomez, J.L.

AU - Villanueva, J.A.

AU - Gonzalez Hernandez, L.A.

AU - Badial, F.

PY - 2021

Y1 - 2021

N2 - 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 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: 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.

AB - 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 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: 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.

KW - Aged

KW - Delayed Diagnosis

KW - Europe, Eastern

KW - HIV Infections

KW - Humans

KW - Middle Aged

KW - Prospective Studies

KW - Tuberculosis

U2 - 10.1186/s12879-021-06745-w

DO - 10.1186/s12879-021-06745-w

M3 - Article

C2 - 34615474

SN - 1471-2334

VL - 21

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1