Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study.

Efsen, A M W; Schultze, A; Miller, R F; Panteleev, A; Skrahin, A; Podlekareva, D N; Miro, J M; Girardi, E; Furrer, Hansjakob; Losso, M H; Toibaro, J; Caylà, J A; Mocroft, A; Lundgren, J D; Post, F A; Kirk, O (2018). Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study. Journal of infection, 76(1), pp. 44-54. Elsevier 10.1016/j.jinf.2017.10.007

[img]
Preview
Text
1-s2.0-S0163445317303201-main.pdf - Accepted Version
Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND).

Download (1MB) | Preview
[img] Text
1-s2.0-S0163445317303201-main.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Furrer, Hansjakob

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0163-4453

Publisher:

Elsevier

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

28 Dec 2017 09:26

Last Modified:

21 Oct 2018 02:30

Publisher DOI:

10.1016/j.jinf.2017.10.007

PubMed ID:

29061336

Uncontrolled Keywords:

Eastern Europe HIV MDR-TB Tuberculosis

BORIS DOI:

10.7892/boris.106663

URI:

https://boris.unibe.ch/id/eprint/106663

Actions (login required)

Edit item Edit item
Provide Feedback