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

2021; BioMed Central; Volume: 21; Issue: 1 Linguagem: Inglês

10.1186/s12879-021-06745-w

1471-2334

Christian Kraef, Adrian Bentzon, Alexander Panteleev, Alena Skrahina, Natalie Bolokadze, Simona Tetradov, Regina Podlasin, Igor Karpov, Е. А. Бородулина, E.A. Denisova, Inga Ažiņa, Jens Lundgren, Işık Somuncu Johansen, Amanda Mocroft, Daria Podlekareva, Ole Kirk, Anna Vassilenko, Dzmitry Klimuk, О. В. Кондратенко, Aksana Zalutskaya, В. Н. Бондаренко, В. М. Мицура, Е. И. Козорез, О. Л. Тумаш, O. Suetnov, D. Paduto, V. Iljina, Tiina Kummik, Ketevan Mshvidobadze, N. Lanchava, Leila Goginashvili, Lali Mikiashvili, Nino Bablishvili, B Rozentale, Indra Zeltiņa, I. Janushkevich, Irma Čaplinskienė, Saulius Čaplinskas, Zavinta Kancauskiene, Alicja Wiercińska‐Drapało, M. Thompson, Joanna Kozłowska, A. Grezesczuk, Maciej Bura, Brygida Knysz, Małgorzata Inglot, Aleksander Garlicki, Jolanta Loster, D. D uiculescu, Aza Rakhmanova, O. O. Panteleev, A. A. Yakovlev, А. Е. Козлов, A. Tyukalova, Yu. Yu. Vlasova, T. T. rofimov, Galyna Kyselyova, Niels Obel, Jan Gerstoft, Gitte Kronborg, M. C. Payen, K. K abeya, Coca Necsoi, François Dabis, A. Tsaranazy, Charles Cazanave, Hansjakob Furrer, M. Sagette, Martin Rickenbach, Delphine Sculier, Alexandra Calmy, Matthias Cavassini, Andrés Bruno, Eric Bernasconi, Matthew Hoffmann, P Vernazza, Jan Fehr, Rachel Weber, Robert F. Miller, Nina Vora, Graham Cooke, Scott Mullaney, E. Wilkins, Varghese George, Paul Collini, David H. Dockrell, Frank A. Post, Lucy Campbell, Ricardo Brum, E. Mabonga, Priyanka Saigal, Stephen Kegg, J. Ainsworth, A. Waters, Jyoti Dhar, Kathryn A. Ellis, Enrico Girardi, Alessia Rianda, Vincenzo Galati, Carmela Pinnetti, Chiara Tommasi, Giuseppe Lapadula, Antonio Di Biagio, Andrea Parisini, Santa Carbonara, Gioacchino Angarano, M. Purgatorio, Alberto Matteelli, A. Apostoli, José M. Miró, Christian Manzardo, Carme Ligero, Juan González, José A. Martı́nez-Martı́nez, F. García‐Sánchez, Hernando Knobel, María Salvadó, José L. López-Colomés, Xavier Martínez-Lacasa, E. Cuchí, Vicenç Falcó, Adrián Curran, Teresa Tórtola, I Ocaña, Rafael Vidal, Ma Antònia Sambeat, Virginia Pomar, Pere Coll, D. Pozamczer, María Saumoy, Fernando Alcaide, Joan A. Caylà, A. Moreno, Joan-Pau Millet, Àngels Orcau, Laia Fina, Amparo Romero, Llanos Roldán, J. A. Iribarren, Maialen Ibarguren, Santiago Moreno, Alejandra González, Pilar Miralles, Teresa Aldámiz‐Echevarría, M Losso, Javier Toibaro, L Gambardella, Javier Toibaro, L. Moreno Macias, Eduardo Warley, Silvina Tavella, Oscar García Messina, O. Gear, H. Laplume, C. Marson, J. Contarelia, M.G. Michaan, Pablo Scapellato, B. Bartoletti, Domingo Palmero, Carlos del Ojo Elías, Claudia P. Cortés, Brenda Crabtree, Juan Luis Mosqueda-Gómez, J. A. Villanueva, L. A. Gonzalez Hernandez, F. Badial,

Infectious Diseases and Tuberculosis

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.