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Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina
Special Author Introduction
Podlekareva et al. • AIDS • 2009 • Volume 23 - Issue 18
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In Europe, countries of the former Soviet Union are of particular concern due to a recent substantial increase in the HIV-epidemic combined with a particularly high prevalence of TB in the general population (1,3). The later is associated with recent political and economic changes in this region (2). In addition, there is a large number of injecting drug users in this region, who are at high risk of both diseases (4-5). Thus, the number of HIV/TB co-infected patients is rapidly increasing. Furthermore, due to patients' poor adherence and possibly suboptimal treatment options, there is a potential threat of an increasing prevalence of multi-drug resistant TB (MDR-TB) among the HIV-infected population, where patients' prognosis becomes very poor and treatment options are quite limited (6-7).
Despite the above, the clinical epidemiology of the HIV/TB epidemic in eastern Europe remains poorly defined. Limited data sources, including from observational cohorts, are available concerning the situation in this region. Surveillance infrastructure and collaboration between HIV and TB services are poorly developed.
Our article presents results from the first international project studying the epidemiological and clinical presentation of HIV/TB coinfection and its outcomes in Europe and Argentina. The analysis was performed on 1075 HIV/TB patients and presents unique results which have not previously been documented. Of particular note, 54% of the patients were from eastern Europe, an area where data is most scarce. Only half of the patients from this region with resistance test performed had a fully susceptible mycobacteria strains and MDR-TB was detected in 12% of cases. There was a profound regional difference in clinical prognosis after TB diagnosis. The one-year mortality was approximately 30% in eastern Europe compared with 7-11% in western Europe and Argentina. We have identified several issues associated with management and clinical outcome of HIV/TB coinfected patients in eastern Europe, including inferior use of antiretroviral as well as anti-TB therapies. Target interventions to optimise management and to reduce the alarmingly high mortality of HIV/TB patients in eastern Europe are urgently needed.
If the use of antiretroviral and anti-TB therapies in eastern Europe is not significantly improved, the prevalence of TB-coinfection is bound to deteriorate as the HIV-epidemic matures and the number of profoundly immunodeficient HIV-patients increases. The study therefore not only points to clinical issues, but also to potentially increasing public health issues related to HIV/TB coinfection.
References:
1. Global tuberculosis control: surveillance, planning, financing: WHO report 2008. Geneva (WHO/HTM/TB/2008.393)
2. Shilova MV. Specific features of the spread of tuberculosis in Russia at the end of the 20th century. Ann N Y Acad Sci 2001 December;953:124-32
3. Lazarus JV, Bollerup A, Matic S. HIV/AIDS in eastern Europe: more than a sexual health crisis. Cent Eur J Public Health 2006 June;14(2):55-8
4. Selwyn PA, Sckell BM, Alcabes P, Friedland GH, Klein RS, Schoenbaum EE. High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy. JAMA 1992 July 22;268(4):504-9.
5. Aceijas C, Stimson GV, Hickman M, Rhodes T. Global overview of injecting drug use and HIV infection among injecting drug users. AIDS 2004 November 19;18(17):2295-303
6. Espinal MA. The global situation of MDR-TB. Tuberculosis (Edinb ) 2003;83(1-3):44-51.
7. Sungkanuparph S, Eampokalap B, Chottanapund S, Thongyen S, Manosuthi W. Impact of drug-resistant tuberculosis on the survival of HIV-infected patients. Int J Tuberc Lung Dis 2007 March;11(3):325-30
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