东欧、西欧和拉丁美洲接受利福平及异烟肼敏感型结核病治疗的HIV阳性患者的一年死亡率。
One-year mortality of HIV-positive patients treated for rifampicin- and isoniazid-susceptible tuberculosis in Eastern Europe, Western Europe, and Latin America.
出版信息
AIDS. 2017 Jan 28;31(3):375-384. doi: 10.1097/QAD.0000000000001333.
OBJECTIVES
The high mortality among HIV/tuberculosis (TB) coinfected patients in Eastern Europe is partly explained by the high prevalence of drug-resistant TB. It remains unclear whether outcomes of HIV/TB patients with rifampicin/isoniazid-susceptible TB in Eastern Europe differ from those in Western Europe or Latin America.
METHODS
One-year mortality of HIV-positive patients with rifampicin/isoniazid-susceptible TB in Eastern Europe, Western Europe, and Latin America was analysed and compared in a prospective observational cohort study. Factors associated with death were analysed using Cox regression modelsRESULTS:: Three hundred and forty-one patients were included (Eastern Europe 127, Western Europe 165, Latin America 49). Proportions of patients with disseminated TB (50, 58, 59%) and initiating rifampicin + isoniazid + pyrazinamide-based treatment (93, 94, 94%) were similar in Eastern Europe, Western Europe, and Latin America respectively, whereas receipt of antiretroviral therapy at baseline and after 12 months was lower in Eastern Europe (17, 39, 39%, and 69, 94, 89%). The 1-year probability of death was 16% (95% confidence interval 11-24%) in Eastern Europe, vs. 4% (2-9%) in Western Europe and 9% (3-21%) in Latin America; P < 0.0001. After adjustment for IDU, CD4 cell count and receipt of antiretroviral therapy, those residing in Eastern Europe were at nearly 3-fold increased risk of death compared with those in Western Europe/Latin America (aHR 2.79 (1.15-6.76); P = 0.023).
CONCLUSIONS
Despite comparable use of recommended anti-TB treatment, mortality of patients with rifampicin/isoniazid-susceptible TB remained higher in Eastern Europe when compared with Western Europe/Latin America. The high mortality in Eastern Europe was only partially explained by IDU, use of ART and CD4 cell count. These results call for improvement of care for TB/HIV patients in Eastern Europe.
目的
东欧地区艾滋病毒/结核病（TB）合并感染患者的高死亡率部分归因于耐多药结核病的高流行率。目前尚不清楚东欧地区利福平/异烟肼敏感结核病的艾滋病毒/结核病患者的治疗结果与西欧或拉丁美洲的患者是否存在差异。
方法
在一项前瞻性观察队列研究中，对东欧、西欧和拉丁美洲利福平/异烟肼敏感结核病的艾滋病毒阳性患者的一年死亡率进行了分析和比较。使用Cox回归模型分析与死亡相关的因素。
结果
共纳入341例患者（东欧127例，西欧165例，拉丁美洲49例）。东欧、西欧和拉丁美洲播散性结核病患者的比例（分别为50%、58%、59%）以及开始基于利福平+异烟肼+吡嗪酰胺治疗的患者比例（分别为93%、94%、94%）相似，而东欧地区基线时和12个月后接受抗逆转录病毒治疗的比例较低（分别为17%、39%、39%和69%、94%、89%）。东欧地区1年死亡概率为16%（95%置信区间11%-24%），西欧为4%（2%-9%），拉丁美洲为9%（3%-21%）；P<0.0001。在对注射吸毒、CD4细胞计数和抗逆转录病毒治疗的接受情况进行调整后，与西欧/拉丁美洲相比，东欧地区居民的死亡风险增加了近3倍（调整后风险比2.79（1.15-6.76）；P=0.023）。
结论
尽管推荐的抗结核治疗使用情况相当，但与西欧/拉丁美洲相比，东欧地区利福平/异烟肼敏感结核病患者的死亡率仍然较高。东欧地区的高死亡率仅部分由注射吸毒、抗逆转录病毒治疗的使用和CD4细胞计数来解释。这些结果呼吁改善东欧地区结核病/艾滋病毒患者的护理。
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