Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients
D N Podlekareva, D Grint, F A Post, A Mocroft, A M Panteleev, R F Miller, J M Miro, M Bruyand, H Furrer, V Riekstina, E Girardi, M H Losso, J A Caylá, E A Malashenkov, N Obel, A M Skrahina, J D Lundgren, O Kirk, HIV-TB Study Group, M H Losso, J J Toibaro, E Warley, N Tamayo, M Cristina Ortiz, P Scapelatto, E Bottaro, F Murano, M Miachans, J Contarelli, L Massera, J Corral, M Hualde, C Miglioranza, M Corti, H Metta, A Casiró, R Cuini, H Laplume, D David, C Marson, S Lupo, L Trape, O Garcia Messina, O Gear, J J Toibaro, J M Bruguera, I Karpov, A Vasilenko, E Skrahina, A Skrahin, V Mitsura, E Kozorez, D Ruzanov, V Bondarenko, O Suetnov, D Paduto, N Obel, F Dabis, M Bruyand, A Matteelli, A C Carvalho, R Basché, I E Hamad, B A Ricci, F Maggiolo, V Ravasio, C Mussini, F Prati, S Castelletti, L Spallanzani, A Antinori, G Antonucci, C Bibbolino, G Bove, E Busi Rizzi, S Cicalini, A Conte, G Cuzzi, P De Mori, A Festa, E Girardi, D Goletti, S Grisetti, G Gualano, F N Lauria, R Maddaluno, P Migliorisi Ramazzini, P Narciso, L Parracino, F Palmieri, N Petrosillo, L Pucillo, V Puro, P Vanacore, R Urso, E Girardi, V Riekstina, P Aldins, I Zeltina, D Duiculescu, A Rakhmanova, E Malashenkov, A Kozlov, A Panteleev, S Buzunova, J M Miro, C Manzardo, J F García-Goez, A Moreno-Camacho, J A Martínez, J González, F García-Alcaide, I Pérez, J M Gatell, P Sánchez, J L López-Colomes Mutua de Terrassa, X Martínez-Lacasa, V Falcó A Imaz, I Ocaña, R Vidal, M A Sambeat, J Caylà, A Moreno-Martínez, J P Millet, L Fina, L del Baño, A Orcau, J Barth, M Battegay, E Bernasconi, J Böni, H C Bucher, C Burton-Jeangros, A Calmy, M Cavassini, C Cellerai, M Egger, L Elzi, J Fehr, J Fellay, M Flepp, H Furrer, C A Fux, M Gorgievski, H Günthard, D Haerry, B Hasse, H H Hirsch, B Hirschel, I Hösli, C Kahlert, L Kaiser, O Keiser, C Kind, T Klimkait, H Kovari, B Ledergerber, G Martinetti, B Martinez de Tejada, K Metzner, N Müller, D Nadal, G Pantaleo, A Rauch, S Regenass, M Rickenbach, C Rudin, P Schmid, D Schultze, F Schöni-Affolter, J Schüpbach, R Speck, P Taffé, P Tarr, A Telenti, A Trkola, P Vernazza, R Weber, S Yerly, F Post, L Campbell, R Miller, A Arenas-Pinto, N Chentsova, J D Lundgren, D Podlekareva, O Kirk, A Mocroft, J Kjær, M Ellefson, N Chentsova, D Duiculesku, H Furrer, E Girardi, M Bruyand, M H Losso, J D Lundgren, A Panteleev, R Miller, J M Miro, N Obel, F Post, V Riekstina, A Skrahin, J J Toibaro, D N Podlekareva, D Grint, F A Post, A Mocroft, A M Panteleev, R F Miller, J M Miro, M Bruyand, H Furrer, V Riekstina, E Girardi, M H Losso, J A Caylá, E A Malashenkov, N Obel, A M Skrahina, J D Lundgren, O Kirk, HIV-TB Study Group, M H Losso, J J Toibaro, E Warley, N Tamayo, M Cristina Ortiz, P Scapelatto, E Bottaro, F Murano, M Miachans, J Contarelli, L Massera, J Corral, M Hualde, C Miglioranza, M Corti, H Metta, A Casiró, R Cuini, H Laplume, D David, C Marson, S Lupo, L Trape, O Garcia Messina, O Gear, J J Toibaro, J M Bruguera, I Karpov, A Vasilenko, E Skrahina, A Skrahin, V Mitsura, E Kozorez, D Ruzanov, V Bondarenko, O Suetnov, D Paduto, N Obel, F Dabis, M Bruyand, A Matteelli, A C Carvalho, R Basché, I E Hamad, B A Ricci, F Maggiolo, V Ravasio, C Mussini, F Prati, S Castelletti, L Spallanzani, A Antinori, G Antonucci, C Bibbolino, G Bove, E Busi Rizzi, S Cicalini, A Conte, G Cuzzi, P De Mori, A Festa, E Girardi, D Goletti, S Grisetti, G Gualano, F N Lauria, R Maddaluno, P Migliorisi Ramazzini, P Narciso, L Parracino, F Palmieri, N Petrosillo, L Pucillo, V Puro, P Vanacore, R Urso, E Girardi, V Riekstina, P Aldins, I Zeltina, D Duiculescu, A Rakhmanova, E Malashenkov, A Kozlov, A Panteleev, S Buzunova, J M Miro, C Manzardo, J F García-Goez, A Moreno-Camacho, J A Martínez, J González, F García-Alcaide, I Pérez, J M Gatell, P Sánchez, J L López-Colomes Mutua de Terrassa, X Martínez-Lacasa, V Falcó A Imaz, I Ocaña, R Vidal, M A Sambeat, J Caylà, A Moreno-Martínez, J P Millet, L Fina, L del Baño, A Orcau, J Barth, M Battegay, E Bernasconi, J Böni, H C Bucher, C Burton-Jeangros, A Calmy, M Cavassini, C Cellerai, M Egger, L Elzi, J Fehr, J Fellay, M Flepp, H Furrer, C A Fux, M Gorgievski, H Günthard, D Haerry, B Hasse, H H Hirsch, B Hirschel, I Hösli, C Kahlert, L Kaiser, O Keiser, C Kind, T Klimkait, H Kovari, B Ledergerber, G Martinetti, B Martinez de Tejada, K Metzner, N Müller, D Nadal, G Pantaleo, A Rauch, S Regenass, M Rickenbach, C Rudin, P Schmid, D Schultze, F Schöni-Affolter, J Schüpbach, R Speck, P Taffé, P Tarr, A Telenti, A Trkola, P Vernazza, R Weber, S Yerly, F Post, L Campbell, R Miller, A Arenas-Pinto, N Chentsova, J D Lundgren, D Podlekareva, O Kirk, A Mocroft, J Kjær, M Ellefson, N Chentsova, D Duiculesku, H Furrer, E Girardi, M Bruyand, M H Losso, J D Lundgren, A Panteleev, R Miller, J M Miro, N Obel, F Post, V Riekstina, A Skrahin, J J Toibaro
Abstract
Objectives: To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome.
Methods: A total of 1061 HIV patients diagnosed with TB in four regions, Central/Northern, Southern and Eastern Europe and Argentina, between January 2004 and December 2006 were enrolled in the TB-HIV study. A weighted HCI score (range 0-5), based on independent prognostic factors identified in multivariable Cox models and the final score, included performance of TB drug susceptibility testing (DST), an initial TB regimen containing a rifamycin, isoniazid and pyrazinamide, and start of combination antiretroviral treatment (cART).
Results: The mean HCI score was highest in Central/Northern Europe (3.2, 95%CI 3.1-3.3) and lowest in Eastern Europe (1.6, 95%CI 1.5-1.7). The cumulative probability of death 1 year after TB diagnosis decreased from 39% (95%CI 31-48) among patients with an HCI score of 0, to 9% (95%CI 6-13) among those with a score of ≥4. In an adjusted Cox model, a 1-unit increase in the HCI score was associated with 27% reduced mortality (relative hazard 0.73, 95%CI 0.64-0.84).
Conclusions: Our results suggest that DST, standard anti-tuberculosis treatment and early cART may improve outcome for TB-HIV patients. The proposed HCI score provides a tool for future research and monitoring of the management of TB-HIV patients. The highest HCI score may serve as a benchmark to assess TB-HIV management, encouraging continuous health care improvement.
Source: PubMed