Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe : associated factors and effect on mortality-a multicentre prospective cohort study
Kraef, Christian (Heidelberg Institute of Global Health. University of Heidelberg)
Bentzon, Adrian (CHIP (Centre of Excellence for Health. Immunity and Infections). Rigshospitalet. University of Copenhagen)
Panteleev, Alexander (City TB Dispensary)
Skrahina, Alena (Republican Scientific and Practical Center for Pulmonology and Tuberculosis)
Bolokadze, Natalie (Infectious Diseases. AIDS and Clinical Immunology Research Center)
Tetradov, Simona (Dr Carol Davila University of Medicine and Pharmacy (Bucarest, Romania))
Podlasin, Regina (Wojewodski Szpital Zakanzy/Medical University of Warsaw)
Karpov, Igor (Department of Infectious Disease. Belarusian State Medical University)
Borodulina, Elena (Samara State Medical University of the Ministry of Healthcare of the Russian Federation)
Denisova, Elena (Botkin Hospital of Infectious Diseases (St. Petersburg, Rússia))
Azina, Inga (Riga East University Hospital. Latvian Centre of Infectious Diseases)
Lundgren, Jens (CHIP (Centre of Excellence for Health. Immunity and Infections). Rigshospitalet. University of Copenhagen)
Johansen, Isik Somuncu (Odense University Hospital (Dinamarca))
Mocroft, Amanda (Centre for Clinical Research. Epidemiology. Modelling and Evaluation (CREME). Institute for Global Health. UCL)
Podlekareva, Daria (CHIP (Centre of Excellence for Health. Immunity and Infections). Rigshospitalet. University of Copenhagen)
Kirk, Ole (Odense University Hospital (Dinamarca))
Vassilenko, Anna (Belarusian State Medical University (Belarús))
Klimuk, Dzmitry A. (Republican Research and Practical Centre for Pulmonology (Belarús))
Kondratenko, Olga Vladimirovna (Republican Research and Practical Centre for Pulmonology (Belarús))
Zalutskaya, Oksana M. (Republican Research and Practical Centre for Pulmonology (Belarús))
Bondarenko, Vasily (Gomel State Medical University (Belarús))
Mitsura, Viktar M. (Gomel State Medical University (Belarús))
Kozorez, Elena (Gomel State Medical University (Belarús))
Tumash, Oksana L. (Gomel State Medical University (Belarús))
Suetnov, Oleg (Gomel Region Centre for Hygiene (Belarús))
Paduto, Dmitriy (Gomel Region Centre for Hygiene (Belarús))
Iljina, V. (East Viru Central Hospital (Kohtla-Jarv, Estònia ))
Kummik, Tiina (East Viru Central Hospital (Kohtla-Jarve, Estònia ))
Mshvidobadze, Ketevan (Infectious Diseases, AIDS and Clinical Immunology Research Center (Tiblisi, Georgia))
Lanchava, N. (Infectious Diseases, AIDS and Clinical Immunology Research Center (Tiblisi, Georgia))
Goginashvili, Leila M. (National Center for Tuberculosis and Lung Diseases of Georgia (Tibilisi, Georgia))
Mikiashvili, Lali (National Center for Tuberculosis and Lung Diseases of Georgia (Tibilisi, Georgia))
Bablishvili, Nino (National Center for Tuberculosis and Lung Diseases of Georgia (Tibilisi, Georgia))
Rozentale, Baiba (Infectology Centre of Latvia (Riga))
Zeltina, Indra (Infectology Centre of Latvia (Riga))
Janushkevich, I. (Infectology Centre of Latvia (Riga))
Caplinskiene, Irma (Centre for Communicable Diseases and AIDS (Vilnius, Lituània))
Caplinskas, Saulius (Centre for Communicable Diseases and AIDS (Vilnius, Lituània))
Kancauskiene, Zavinta (Centre for Communicable Diseases and AIDS (Vilnius, Lituània))
Wiercinska-Drapalo, Alicja (Wojewodski Szpital Zakanzy/Medical University of Warsaw (Warszawa, Polònia))
Thompson, Magdalena E. (Wojewodski Szpital Specjalistyczny/Medical University Teaching Hospital (Bialystok, Polònia))
Kozlowska, Joanna (Wojewodski Szpital Specjalistyczny/Medical University Teaching Hospital (Bialystok, Polònia))
Grezesczuk, A. (Wojewodski Szpital Specjalistyczny/Medical University Teaching Hospital (Bialystok, Polònia))
Bura, Maciej P. (Jozef Strus Multidisciplinary City Hospital (Poznan. Polònia))
Knysz, Brygida (Wroclaw University School of Medicine (Wroclaw, Polònia))
Inglot, Malgorzata (Wroclaw University School of Medicine (Wroclaw, Polònia))
Garlicki, Aleksander Michal (Jagiellonian University Medical College (Krakow, Polònia))
Loster, J. (Jagiellonian University Medical College (Krakow, Polònia))
Uiculescu, D.D. (Dr. Victor Babes Hospital (Bucharest, Romania))
Rakhmanova, Aza Gasanovna (Botkin Hospital of Infectious Diseases (St. Petersburg, Rússia))
Panteleev, O. (Botkin Hospital of Infectious Diseases (St. Petersburg, Rússia))
Yakovlev, Alexey (Botkin Hospital of Infectious Diseases (St. Petersburg, Rússia))
Kozlov, A. (Botkin Hospital of Infectious Diseases (St. Petersburg, Rússia))
Tyukalova, A. (Botkin Hospital of Infectious Diseases (St. Petersburg, Rússia))
Vlasova, Y. (Botkin Hospital of Infectious Diseases (St. Petersburg, Rússia))
Trofimov, T.T. (Center for Prevention and Control of AIDS (Veliky, Novgorod))
Kyselyova, Galina (Crimean Republican AIDS Centre (Simferopol, Ucraïna))
Obel, Niels (Copenhagen University Hospital Rigshospitale)
Gerstoft, Jan (Rigshospitalet (Cph, Dinamarca))
Kronborg, Gitte (Hvidovre University Hospital ( Dinamarca))
Payen, Marie Christine (CHU Saint-Pierre (Bèlgica))
abeya, K.K. (CHU Saint-Pierre (Bèlgica))
Necsoi, Coca Valentina (CHU Saint-Pierre (Bèlgica))
Dabis, François (Aquitaine Cohort (França))
Tsaranazy, Anjarasoa Aquitaine Cohort (França)
Cazanave, Charles J. (Bordeaux University Hospital (França))
Furrer, Hansjakob (University Hospital Bern (Suïssa))
Sagette, M. (University Hospital Bern (Suïssa))
Rickenbach, Martin (University Hospital Bern (Suïssa))
Sculier, Delphine (Hopital Cantonal Universitaire (Geneve, Suïssa))
Calmy, Alexandra (Hopital Cantonal Universitaire (Geneve, Suïssa))
Cavassini, Matthias (Centre Hospitalaire Universitaire Vaudois (Lausanne, Suïssa))
Bruno, Alessandra (Hospital of Lugano (Suïssa))
Bernasconi, Enos (Hospital of Lugano (Suïssa))
Hoffmann, Matthias (Cantonal Hospital St. Gallen (Suïssa))
Vernazza, Pietro Luigi (Cantonal Hospital St. Gallen (Suïssa))
Fehr, Jan Sven (University Hospital Zurich (Suïssa))
Weber, Rainer (University Hospital Zurich (Suïssa))
Miller, Robert F. (Mortimer Market Centre (Londres))
Vora, Nina (Mortimer Market Centre (Londres))
Cooke, Graham S. (St. Mary's Hospital (Londres))
Mullaney, Scott A. (St. Mary's Hospital (Londres))
Wilkins, Edmund G. L. (North Manchester General Hospital (Regne Unit))
George, Valerie (North Manchester General Hospital (Regne Unit))
Collini, Paul J. (Sheffield Teaching Hospitals (Regne Unit))
Dockrell, David (Sheffield Teaching Hospitals (Regne Unit))
Post, Frank A. (King's College Hospital (Londres))
Campbell, Lucy J. (King's College Hospital (Londres))
Brum, Roberta Lima (King's College Hospital (Londres))
Mabonga, Emily (King's College Hospital (Londres))
Saigal, Priyanka (King's College Hospital (Londres))
Kegg, Stephen (Queen Elizabeth Hospital (Regne Unit))
Ainsworth, Jonathan G. (North Middelsex University Hospital (Regne Unit))
Waters, Anele (North Middelsex University Hospital (Regne Unit))
Dhar, Jyoti (Leicester Royal Infirmary)
Ellis, K. (Leicester Royal Infirmary)
Girardi, Enrico (IRCCS-Ospedale L. Spallanzani (Roma, Itàlia))
Rianda, Alessia (IRCCS-Ospedale L. Spallanzani (Roma, Itàlia))
Galati, Vincenzo (IRCCS-Ospedale L. Spallanzani (Roma, Itàlia))
Pinnetti, Carmela (IRCCS-Ospedale L. Spallanzani (Roma, Itàlia))
Tommasi, Chiara (IRCCS-Ospedale L. Spallanzani (Roma, Itàlia))
Lapadula, Giuseppe (AO San Gerardo (Monza, Itàlia))
Di Biagio, Antonio (IRCCS Ospedale Policlinico San Martino (Gènova, Itàlia))
Parisini, Andrea (IRCCS Ospedale Policlinico San Martino (Gènova, Itàlia))
Carbonara, Sergio (Clinic of Infectious Diseases, University of Bari (Bari, Itàlia))
Angarano, Gioacchino (Clinic of Infectious Diseases, University of Bari (Bari, Itàlia))
Purgatorio, Mariantonietta (Clinic of Infectious Diseases, University of Bari (Bari, Itàlia))
Matteelli, Alberto (University of Brescia Spedali Civili (Brescia, Itàlia))
Apostoli, Alessandra (University of Brescia Spedali Civili (Brescia, Itàlia))
Miro, José María (Hospital Clínic i Provincial de Barcelona)
Manzardo, Christian (Hospital Clínic i Provincial de Barcelona)
Ligero, Carmen (Hospital Clínic i Provincial de Barcelona)
Gonzalez-Martin, Julian (Hospital Clínic i Provincial de Barcelona)
Martinez-Martinez, José Antonio (Hospital Clínic i Provincial de Barcelona)
Sanchez, Francesca (Hospital del Mar)
Knobel Freud, Hernando (Hospital del Mar)
Salvadó, Meritxell (Hospital del Mar)
Lopez-Colomes, Josep Luís (Hospital del Mar)
Martínez-Lacasa, Xavier (Mutua de Terrassa)
Cuchí, E. (Mutua de Terrassa)
Falcó, Vicenç (Hospital Universitari Vall d'Hebron)
Curran, Adrian (Hospital Universitari Vall d'Hebron)
Tortola, M.T. (Hospital Universitari Vall d'Hebron)
Ocaña Rivera, Immaculada (Hospital Universitari Vall d'Hebron)
Vidal, R. (Hospital Universitari Vall d'Hebron)
Sambeat, M.A. (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Pomar, Virginia (Institut d'Investigació Biomèdica Sant Pau)
Coll, P. (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Pozamczer, D. (Hospital Universitari de Bellvitge)
Saumoy, Maria (Hospital Universitari de Bellvitge)
Alcaide, Fernando (Hospital Universitari de Bellvitge)
Caylà, Joan A. (Agència de Salut Pública de Barcelona)
Moreno Camacho, Asunción (Agència de Salut Pública de Barcelona)
Millet, Joan Pau (Institut d'Investigació Biomèdica Sant Pau)
Orcau, Àngels (Institut d'Investigació Biomèdica Sant Pau)
Fina, L. (Agència de Salut Pública de Barcelona)
Romero, A. (Agència de Salut Pública de Barcelona)
Roldan, L.L. (Agència de Salut Pública de Barcelona)
Iribarren, José Antonio (Hospital Universitaria Donostia (San Sebastian))
Ibarguren, M. (Hospital Universitaria Donostia (San Sebastian))
Moreno, S. (Hospital Universitario Ramón y Cajal (Madrid))
González, A. (Hospital Universitario Ramón y Cajal (Madrid))
Miralles, Pilar (Hospital General Universitario Gregorio Marañón)
Aldámiz-Echevarría, T. (Hospital General Universitario Gregorio Marañón)
Losso, M. (The CICAL Cohort, Argentina)
Toibaro, J. (The CICAL Cohort, Argentina)
Gambardella, L. (The CICAL Cohort, Argentina)
Moreno Macias, L. Hospital J. M. Ramos Mejía (Buenos Aires)
Warley, E. (Hospital Paroissien (BA))
Tavella, S. (Hospital Paroissien (BA))
Garcia Messina, O. (Hospital Piñero (BA))
Gear, O. (Hospital Piñero (BA))
Laplume, H. (Hospital Nacional Profesor Alejandro Posadas)
Marson, C. (Hospital Rawson (Cordoba))
Contarelia, J. (Hospital San Juan de Dios (La Plata))
Michaan, M. (Hospital San Juan de Dios (La Plata))
Scapellato, P. (Hospital General de Agudos Donación F. Santojani)
Bartoletti, B. (Hospital Francisco Javier Muñiz (BA))
Palmero, D. (Hospital Francisco Javier Muñiz (BA))
Elias, C. (Hospital Jujuy)
Cortes, C. (Fundación Arriaran (Santiago))
Crabtree, B. (INNcMZS (México DF))
Mosqueda Gomez, J.L. (Hospital General Regional de León)
Villanueva, J.A. (Hospital Civil de Guadalajara)
Gonzalez Hernandez, L.A. (Hospital Civil de Guadalajara)
Badial, F. (Hospital Civil de Guadalajara)

Data:	2021
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Aged ; Delayed Diagnosis ; Europe, Eastern ; HIV Infections ; Humans ; Middle Aged ; Prospective Studies ; Tuberculosis
Publicat a:	BMC Infectious diseases, Vol. 21 Núm. 1 (december 2021) , p. 1038, ISSN 1471-2334

DOI: 10.1186/s12879-021-06745-w
PMID: 34615474

12 p, 957.4 KB

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