Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study.
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BORIS DOI
Date of Publication
January 2018
Publication Type
Article
Division/Institute
Contributor
Efsen, A M W | |
Schultze, A | |
Miller, R F | |
Panteleev, A | |
Skrahin, A | |
Podlekareva, D N | |
Miro, J M | |
Girardi, E | |
Losso, M H | |
Toibaro, J | |
Caylà, J A | |
Mocroft, A | |
Lundgren, J D | |
Post, F A | |
Kirk, O |
Subject(s)
Series
Journal of infection
ISSN or ISBN (if monograph)
0163-4453
Publisher
Elsevier
Language
English
Publisher DOI
PubMed ID
29061336
Uncontrolled Keywords
Description
OBJECTIVES
Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce.
METHODS
In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART).
RESULTS
A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5-74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%.
CONCLUSIONS
Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care.
Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce.
METHODS
In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART).
RESULTS
A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5-74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%.
CONCLUSIONS
Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care.
File(s)
| File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
|---|---|---|---|---|---|---|---|
| 1-s2.0-S0163445317303201-main.pdf | text | Adobe PDF | 1.31 MB | Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND 4.0) | accepted | ||
| 1-s2.0-S0163445317303201-main.pdf | text | Adobe PDF | 1.16 MB | publisher | published |