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Title: Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality-a multicentre prospective cohort study
Author: Kraef, Christian
Bentzon, Adrian
Panteleev, Alexander
Skrahina, Alena
Bolokadze, Natalie
Tetradov, Simona
Podlasin, Regina
Karpov, Igor
Borodulina, Elena
Denisova, Elena
Azina, Inga
Lundgren, Jens D.
Johansen, Isik Somuncu
Mocroft, Amanda
Podlekareva, Daria N.
Kirk, Ole
Keywords: VIH (Virus)
Europa de l'Est
HIV (Viruses)
Eastern Europe
Issue Date: Oct-2021
Publisher: BioMed Central
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.
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It is part of: BMC Infectious Diseases, 2021, vol. 21, num. 1, p. 1038
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ISSN: 1471-2334
Appears in Collections:Articles publicats en revistes (Medicina)
Articles publicats en revistes (Patologia i Terapèutica Experimental)

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