The socio-demographic, clinical characteristics and outcomes of tuberculosis among HIV infected adults in Lithuania: A thirteen-year analysis

Elzbieta Matulyte; Edita Davidaviciene; Zavinta Kancauskiene; Saulius Diktanas; Aidas Kausas; Daiva Velyvyte; Jurgita Urboniene; Vilnele Lipnickiene; Megan Laurencikaite; Edvardas Danila; Dominique Costagliola; Raimonda Matulionyte

doi:10.1371/journal.pone.0282046

The socio-demographic, clinical characteristics and outcomes of tuberculosis among HIV infected adults in Lithuania: A thirteen-year analysis

PLoS One. 2023 Mar 23;18(3):e0282046. doi: 10.1371/journal.pone.0282046. eCollection 2023.

Authors

Affiliations

¹ Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
² Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
³ State Information System of Tuberculosis, Public Health Department, Ministry of Health, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
⁴ AIDS Centre, Department of Infectious Diseases, University Hospital of Klaipeda, Klaipeda, Lithuania.
⁵ Tuberculosis Department, Republican Klaipeda Hospital, Klaipeda, Lithuania.
⁶ Adult Infectious Diseases Unit, Clinic of Conservative Medicine, Republican Siauliai County Hospital, Siauliai, Lithuania.
⁷ Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁸ Kaunas Hospital of the Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁹ National Public Health Surveillance Laboratory, Vilnius, Lithuania.
¹⁰ Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹¹ Clinic of Chest Diseases, Immunology, and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹² Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
¹³ Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie de Santé Publique, Paris, France.

Abstract

Background: Tuberculosis (TB) is a public health problem in Lithuania, among the 18 high-priority TB countries in the European region, and the most common AIDS-indicative disease with the highest proportion in the EU/EEA since 2015. The study aimed to identify socio-demographic, clinical characteristics and their relationship with TB outcomes in TB-HIV co-infected patients in Lithuania.

Methods: A retrospective chart review analysed the characteristics of TB-HIV co-infected adults registered in State Information System of Tuberculosis over 2008-2020. The factors associated with drug-resistant TB and unsuccessful treatment outcome were identified by multivariable logistic regression.

Results: The study included 345 cases in 311 patients (239 new, 106 previously treated cases), median age 40 years (IQR 35-45), 80.7% male. 67.8% patients knew their HIV-positive status before TB diagnosis, median time to TB diagnosis was 8 years (IQR 4-12). 83.6% were unemployed, 50.5%-anytime intravenous drug users (IDU), 34.9% abused alcohol. Drug-resistant TB rates in new and previously treated TB cases were 38.1% and 61.3%, respectively. In multivariable analysis, higher risk of drug-resistant TB was associated with imprisonment in new (aOR 3.35; 95%CI 1.17-9.57) and previously treated (aOR 6.63; 95%CI 1.09-40.35) cases. In 52.3% of new TB cases and in 42.5% previously treated TB cases the treatment outcomes were unsuccessful. In multivariable analysis of new TB cases, current imprisonment (aOR 2.77; 95%CI 1.29-5.91) and drug-resistant TB (aOR 2.18; 95%CI 1.11-4.28) were associated with unsuccessful treatment outcome. In multivariable analysis of previously treated TB cases, female gender (aOR 11.93; 95%CI 1.86-76.69), alcohol abuse (aOR 3.17; 95%CI 1.05-9.58), drug-resistant TB (aOR 4.83; 95%CI 1.53-15.28) were associated with unsuccessful treatment outcome.

Conclusions: In the TB-HIV-infected adult cohort in Lithuania, unemployment, imprisonment, IDU, alcohol abuse, known to be risk factors for TB, were very frequent. Drug resistance was an undeniable risk factor for unsuccessful treatment outcome and imprisonment was associated with drug resistant TB.

Copyright: © 2023 Matulyte et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acquired Immunodeficiency Syndrome* / drug therapy
Adult
Alcoholism* / complications
Antitubercular Agents / therapeutic use
Demography
Female
HIV Infections* / complications
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Lithuania / epidemiology
Male
Retrospective Studies
Risk Factors
Treatment Outcome
Tuberculosis* / complications
Tuberculosis* / drug therapy
Tuberculosis* / epidemiology
Tuberculosis, Multidrug-Resistant* / complications
Tuberculosis, Multidrug-Resistant* / drug therapy
Tuberculosis, Multidrug-Resistant* / epidemiology

Substances

Antitubercular Agents

Grants and funding

EM, ZK, AK and RM received grants in the frame of the project “Run-up to programmatic management of latent tuberculosis infection in HIV-infected people in Lithuania“, Project ID 482020, funded by the Western-Eastern European Partnership Initiative on HIV, Viral Hepatitis and TB (WEEPI, www.weepi.org). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.