东欧艾滋病毒感染者患结核病后的长期结局。

Long-term outcomes after tuberculosis for people with HIV in eastern Europe.

作者信息

Kraef Christian, Bentzon Adrian, Roen Ashley, Bolokadze Natalie, Thompson Magdalena, Azina Inga, Tetradov Simona, Skrahina Alena, Karpov Igor, Mitsura Viktar, Paduto Dmitriy, Trofimova Tatiana, Borodulina Elena, Mocroft Amanda, Kirk Ole, Podlekareva Daria N

机构信息

Centre of Excellence for Health, Immunity and Infections, and.

Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark.

出版信息

AIDS. 2023 Nov 1;37(13):1997-2006. doi: 10.1097/QAD.0000000000003670. Epub 2023 Jul 27.

DOI:10.1097/QAD.0000000000003670

PMID:37503671

Abstract

BACKGROUND

Eastern Europe has a high burden of tuberculosis (TB)/HIV coinfection with high mortality shortly after TB diagnosis. This study assesses TB recurrence, mortality rates and causes of death among TB/HIV patients from Eastern Europe up to 11 years after TB diagnosis.

METHODS

A longitudinal cohort study of TB/HIV patients enrolled between 2011 and 2013 (at TB diagnosis) and followed-up until end of 2021. A competing risk regression was employed to assess rates of TB recurrence, with death as competing event. Kaplan-Meier estimates and a multivariable Cox-regression were used to assess long-term mortality and corresponding risk factors. The Coding Causes of Death in HIV (CoDe) methodology was used for adjudication of causes of death.

RESULTS

Three hundred and seventy-five TB/HIV patients were included. Fifty-three (14.1%) were later diagnosed with recurrent TB [incidence rate 3.1/100 person-years of follow-up (PYFU), 95% confidence interval (CI) 2.4-4.0] during a total follow-up time of 1713 PYFU. Twenty-three of 33 patients with data on drug-resistance (69.7%) had multidrug-resistant (MDR)-TB. More than half with recurrent TB ( n = 30/53, 56.6%) died. Overall, 215 (57.3%) died during the follow-up period, corresponding to a mortality rate of 11.4/100 PYFU (95% CI 10.0-13.1). Almost half of those (48.8%) died of TB. The proportion of all TB-related deaths was highest in the first 6 ( n = 49/71; 69%; P < 0.0001) and 6-24 ( n = 33/58; 56.9%; P < 0.0001) months of follow-up, compared deaths beyond 24 months ( n = 23/85; 26.7%).

CONCLUSION

TB recurrence and TB-related mortality rates in PWH in Eastern Europe are still concerningly high and continue to be a clinical and public health challenge.

摘要

背景

东欧地区结核病（TB）/艾滋病毒合并感染负担沉重，结核病诊断后不久死亡率很高。本研究评估了东欧地区结核病/艾滋病毒患者在结核病诊断后长达11年的结核病复发率、死亡率及死亡原因。

方法

对2011年至2013年期间登记（结核病诊断时）的结核病/艾滋病毒患者进行纵向队列研究，并随访至2021年底。采用竞争风险回归评估结核病复发率，将死亡作为竞争事件。采用Kaplan-Meier估计法和多变量Cox回归评估长期死亡率及相应风险因素。使用艾滋病毒死亡原因编码（CoDe）方法判定死亡原因。

结果

纳入375例结核病/艾滋病毒患者。在总计1713人年的随访时间里，53例（14.1%）后来被诊断为复发性结核病[发病率为3.¹/100人年随访时间（PYFU），95%置信区间（CI）2.4 - 4.0]。在33例有耐药数据的患者中，23例（69.7%）患有耐多药（MDR）结核病。超过一半的复发性结核病患者（n = 30/53，56.6%）死亡。总体而言，215例（57.3%）在随访期间死亡，死亡率为11.4/100 PYFU（95% CI 10.0 - 13.1）。其中近一半（48.8%）死于结核病。在随访的前6个月（n = 49/71；69%；P < 0.000¹）和6 - 24个月（n = 33/58；56.9%；P < 0.000¹），所有结核病相关死亡的比例最高，相比之下，随访24个月后死亡的比例为（n = 23/85；26.7%）。