Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe

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...

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Detalhes bibliográficos
Autores: Kraef, Christian|||0000-0002-5224-0335, Bentzon, Adrian, Panteleev, Alexander, Skrahina, Alena, Bolokadze, Natalie, Tetradov, Simona, Podlasin, Regina, Karpov, Igor, Borodulina, Elena, Denisova, Elena, Azina, Inga|||0000-0003-3058-9066, Lundgren, Jens|||0000-0001-8901-7850, Johansen, Isik Somuncu|||0000-0002-2189-9823, Mocroft, Amanda, Podlekareva, Daria|||0000-0003-3187-0597, Kirk, Ole, Vassilenko, Anna|||0000-0003-1907-2322, Klimuk, Dzmitry A., Kondratenko, Olga Vladimirovna, Zalutskaya, Oksana M., Bondarenko, Vasily|||0000-0003-2701-2207, Mitsura, Viktar M.|||0000-0002-0449-5026, Kozorez, Elena|||0000-0002-2844-8603, Tumash, Oksana L.|||0000-0002-1020-3704, Suetnov, Oleg, Paduto, Dmitriy, Iljina, V., Kummik, Tiina, Mshvidobadze, Ketevan, Lanchava, N., Goginashvili, Leila M., Mikiashvili, Lali, Bablishvili, Nino, Rozentale, Baiba, Zeltina, Indra, Janushkevich, I., Caplinskiene, Irma, Caplinskas, Saulius, Kancauskiene, Zavinta, Wiercinska-Drapalo, Alicja|||0000-0001-5921-1409, Thompson, Magdalena E., Kozlowska, Joanna|||0000-0002-0819-5194, Grezesczuk, A., Bura, Maciej P., Knysz, Brygida, Inglot, Malgorzata, Garlicki, Aleksander Michal, Loster, J., Uiculescu, D.D., Rakhmanova, Aza Gasanovna, Panteleev, O., Yakovlev, Alexey|||0000-0003-4163-5769, Kozlov, A., Tyukalova, A., Vlasova, Y., Trofimov, T.T., Kyselyova, Galina, Obel, Niels|||0000-0002-5031-0045, Gerstoft, Jan, Kronborg, Gitte, Payen, Marie Christine, abeya, K.K., Necsoi, Coca Valentina, Dabis, François, Tsaranazy, Anjarasoa Aquitaine Cohort (França), Cazanave, Charles J., Furrer, Hansjakob, Sagette, M., Rickenbach, Martin, Sculier, Delphine, Calmy, Alexandra|||0000-0002-1137-6826, Cavassini, Matthias, Bruno, Alessandra, Bernasconi, Enos, Hoffmann, Matthias, Vernazza, Pietro Luigi, Fehr, Jan Sven, Weber, Rainer, Miller, Robert F., Vora, Nina, Cooke, Graham S., Mullaney, Scott A., Wilkins, Edmund G. L., George, Valerie, Collini, Paul J., Dockrell, David|||0000-0002-2718-4861, Post, Frank A., Campbell, Lucy J., Brum, Roberta Lima, Mabonga, Emily, Saigal, Priyanka, Kegg, Stephen, Ainsworth, Jonathan G., Waters, Anele, Dhar, Jyoti, Ellis, K., Girardi, Enrico, Rianda, Alessia, Galati, Vincenzo, Pinnetti, Carmela|||0000-0003-1350-4032, Tommasi, Chiara, Lapadula, Giuseppe|||0000-0002-9976-8102, Di Biagio, Antonio|||0000-0003-1436-5089, Parisini, Andrea|||0000-0002-6235-4379, Carbonara, Sergio, Angarano, Gioacchino, Purgatorio, Mariantonietta, Matteelli, Alberto, Apostoli, Alessandra, Miró, José M.|||0000-0001-8057-7755, Manzardo, Christian, Ligero, Carmen|||0000-0003-4851-7810, Gonzalez-Martin, Julian|||0000-0001-7248-6706, Martinez-Martinez, José Antonio, Sánchez-Martínez, Francesca|||0000-0001-8198-1661, Knobel Freud, Hernando|||0000-0003-3186-6416, Salvadó, Meritxell, Lopez-Colomes, Josep Luís, Martínez-Lacasa, Xavier, Cuchí, E., Falcó, Vicenç|||0000-0001-9626-0023, Curran, Adrian|||0000-0002-1263-0814, Tortola, M.T., Ocaña Rivera, Immaculada|||0000-0003-3699-0790, Vidal, R., Sambeat, M.A., Pomar, Virginia|||0000-0002-8473-5834, Coll, P., Pozamczer, D., Saumoy, Maria|||0000-0002-0047-1991, Alcaide, Fernando|||0000-0002-4097-1499, Caylà, Joan A.|||0000-0003-3891-111X, Moreno Camacho, Asunción|||0000-0001-6382-0039, Millet, Joan Pau|||0000-0003-0200-2459, Orcau, Àngels|||0000-0001-8109-7614, Fina, L., Romero, A., Roldan, L.L., Iribarren, José Antonio, Ibarguren, M., Moreno, S., González, A., Miralles, Pilar, Aldámiz-Echevarría, T., Losso, M., Toibaro, J., Gambardella, L., Moreno Macias, L. Hospital J. M. Ramos Mejía (Buenos Aires), Warley, E., Tavella, S., Garcia Messina, O., Gear, O., Laplume, H., Marson, C., Contarelia, J., Michaan, M., Scapellato, P., Bartoletti, B., Palmero, D., Elias, C., Cortes, C., Crabtree, B., Mosqueda Gomez, J.L., Villanueva, J.A., Gonzalez Hernandez, L.A., Badial, F.
Formato: artículo
Fecha de publicación:2021
País:España
Recursos:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:270248
Acesso em linha:https://ddd.uab.cat/record/270248
https://dx.doi.org/urn:doi:10.1186/s12879-021-06745-w
Access Level:acceso abierto
Palavra-chave:Aged
Delayed Diagnosis
Europe, Eastern
HIV Infections
Humans
Middle Aged
Prospective Studies
Tuberculosis
Descrição
Resumo: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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