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

Area of Science:

• Infectious Diseases
• Public Health
• Epidemiology

Background:

• Eastern Europe faces a substantial burden of tuberculosis (TB) and HIV coinfection.
• High mortality rates are observed shortly after TB diagnosis in coinfected individuals.
• This study investigates long-term outcomes for TB/HIV patients in the region.

Purpose of the Study:

• To assess TB recurrence rates among TB/HIV patients in Eastern Europe.
• To determine mortality rates and causes of death in this population up to 11 years post-TB diagnosis.
• To identify risk factors associated with long-term mortality.

Main Methods:

• A longitudinal cohort study followed 375 TB/HIV patients from 2011-2013 to 2021.
• Competing risk regression analyzed TB recurrence, with death as a competing event.
• Kaplan-Meier estimates and Cox regression assessed mortality and risk factors; Coding Causes of Death in HIV (CoDe) methodology was used for cause of death adjudication.

Main Results:

• A total of 53 patients (14.1%) experienced TB recurrence (3.1/100 PYFU).
• Multidrug-resistant TB (MDR-TB) was prevalent in recurrent cases (69.7%).
• Overall mortality was 57.3% (11.4/100 PYFU), with nearly half of deaths attributed to TB, particularly within the first 24 months of follow-up.

Conclusions:

• TB recurrence and TB-related mortality rates in people with HIV (PWH) in Eastern Europe remain alarmingly high.
• These outcomes represent a persistent clinical and public health challenge.
• Effective interventions are crucial to mitigate the impact of TB/HIV coinfection in this region.