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J Infect. 2018 Jan;76(1):44-54. doi: 10.1016/j.jinf.2017.10.007. Epub 2017 Oct 20.

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

Collaborators (115)

Karpov I13, Vassilenko A13, Skrahina A14, Klimuk D14, Skrahin A14, Kondratenko O14, Zalutskaya A14, Bondarenko V15, Mitsura V15, Kozorez E15, Tumash O15, Suetnov O16, Paduto D16, Iljina V17, Kummik T17, Bolokadze N18, Mshvidobadze K18, Lanchava N18, Goginashvili L19, Mikiashvili L19, Bablishvili N19, Rozentale B20, Zeltina I20, Janushkevich I20, Caplinskiene I21, Caplinskas S21, Kancauskiene Z21, Podlasin R22, Wiercinska-Drapalo A22, Thompson M22, Kozlowska J22, Grezesczuk A23, Bura M24, Knysz B25, Inglot M25, Garlicki A26, Loster J26, Tetradov S27, Duiculescu D27, Rakhmanova A28, Panteleeva O28, Yakovlev A28, Kozlov A28, Tyukalova A28, Vlasova Y28, Panteleev A29, Trofimov T30, Kyselyova G31, Andersen AB32, Thorsteinsson K33, Payen MC34, Kabeya K34, Necsoi C34, Dabis F35, Bruyand M35, Morlat P36, Dupont A37, Gerard Y38, Bonnal F39, Ceccaldi J40, De Witte S41, Monlun E42, Lataste P43, Chossat I44, Miller R45, Vora N45, Cooke G46, Mullaney S46, Wilkins E47, George V47, Collini P48, Dockrell D48, Post F49, Campbell L49, Brum R49, Mabonga E49, Saigal P49, Kegg S50, Ainsworth J51, Waters A51, Dhar J52, Mashonganyika L52, Girardi E53, Rianda A53, Galati V53, Pinnetti C53, Tommasi C53, Lapadula G54, Di Biagio A55, Parisini A55, Carbonara S56, Angarano G56, Purgatorio M56, Matteelli A57, Apostoli A57, Toibaro J58, Macias LM58, Warley E59, Tavella S59, Garcia Messina O60, Gear O60, Laplume H61, Marson C62, Contarelia J63, Michaan M63, Scapellato P64, Alessandro DD64, Bartoletti B65, Palmero D65, Elias C66, Cortes C67, Crabtree B68, Mosqueda Gomez JL69, Villanueva A70, Gonzalez Hernandez LA70.

Author information

1
CHIP, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark. Electronic address: anne.marie.werlinrud.efsen@regionh.dk.
2
Department of Infection and Population Health, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK.
3
Centre for Sexual Health and HIV Research, Mortimer Market Centre, University College London, London WC1E 6JB, UK.
4
Department of HIV/TB, TB hospital 2, Ushinskogo str 39/1 - 122, St. Petersburg 195267, Russia.
5
Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus.
6
CHIP, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark.
7
Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel, 170, Barcelona 08036, Spain.
8
Department of Infectious Diseases INMI "L. Spallanzani", Ospedale L Spallanzani, Via Portuense, 292, Rome 00149, Italy.
9
Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland.
10
Department of immunocompromised, Hospital J.M. Ramos Mejia, Pabellón de Cliníca, 2do Piso, Buenos Aires CP 1221, Argentina.
11
Agencia de Salud Pública de Barcelona, Barcelona, Spain; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
12
Department of Sexual Health, Caldecot Centre, King's College Hospital, Bessemer Road, London SE5 9RS, UK.
13
Belarusian State Medical University, Department of Infectious Disease, Belarus.
14
Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus.
15
Gomel State Medical University, Gomel, Belarus.
16
Gomel Region Centre for Hygiene, Belarus.
17
East Viru Central Hospital, Kohtla-Jarve, Estonia.
18
Infectious Diseases, AIDS and Clinical Immunology Research Center, Tiblisi, Georgia.
19
National Center for Tuberculosis and Lung Diseases of Georgia, Tibilisi, Georgia.
20
Infectology Centre of Latvia, Riga, Latvia.
21
Centre for Communicable Diseases and AIDS, Vilnius, Lithuania.
22
Wojewodski Szpital Zakanzy/Medical University of Warsaw, Warszawa, Poland.
23
Wojewodski Szpital Specjalistyczny/Medical University Teaching Hospital, Bialystok, Poland.
24
Jozef Strus Multidisciplinary City Hospital, Poznan, Poland.
25
Wroclaw University School of Medicine, Wroclaw, Poland.
26
Jagiellonian University Medical College, Krakow, Poland.
27
Dr. Victor Babes Hospital, Bucharest, Romania.
28
Botkin Hospital of Infectious Diseases, St. Petersburg, Russia.
29
City TB Hospital No. 2, St. Petersburg, Russia.
30
Center for Prevention and Control of AIDS, Veliky Novgorod, Russia.
31
Crimean Republican AIDS Centre, Simferopol, Ukraine.
32
Rigshospitalet, Copenhagen, Denmark.
33
Hvidovre University Hospital, Denmark.
34
CHU Saint-Pierre, Brussels, Belgium.
35
Aquitaine Cohort, Cohort Administration, France.
36
Bordeaux University Hospital, France.
37
Arcachon Hospital, France.
38
Dax Hospital, France.
39
Bayonne Hospital, France.
40
Libourne Hospital, France.
41
Mont-de-Marsan Hospital, France.
42
Pau Hospital, France.
43
Périgueux Hospital, France.
44
Villeneuve-sur-Lot Hospital, France.
45
Mortimer Market Centre, London, United Kingdom.
46
St. Mary's Hospital, United Kingdom.
47
North Manchester General Hospital, United Kingdom.
48
Sheffield Teaching Hospitals, United Kingdom.
49
King's College Hospital, London, United Kingdom.
50
Queen Elizabeth Hospital, United Kingdom.
51
North Middlesex University Hospital, United Kingdom.
52
Leicester Royal Infirmary, United Kingdom.
53
IRCCS- Ospedale L. Spallanzani, Rome, Italy.
54
AO San Gerardo, Monza, Italy.
55
IRCCS AOU San Martino - IST di Genoa, Genova, Italy.
56
Clinic of Infectious Diseases, University of Bari, Bari, Italy.
57
University of Brescia Spedali Civili, Italy.
58
Hospital J. M. Ramos Mejía, Buenos Aires, Argentina.
59
Hospital Paroissien, Buenos Aires, Argentina.
60
Hospital Piñero, Buenos Aires, Argentina.
61
Hospital Nacional Profesor Alejandro Posadas, Argentina.
62
Hospital Rawson, Cordoba, Argentina.
63
Hospital San Juan de Dios, La Plata, Argentina.
64
Hospital General de Agudos Donación F. Santojani, Argentina.
65
Hospital Francisco Javier Muñiz, Buenos Aires, Argentina.
66
Hospital Jujuy, Argentina.
67
Fundación Arriaran, Santiago, Chile.
68
INNcMZS, México DF, Mexico.
69
Hospital General Regional de Leon- CAPACITS, Mexico.
70
Hospital Civil de Guadalajara, Mexico.

Abstract

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.

KEYWORDS:

Eastern Europe; HIV; MDR-TB; Tuberculosis

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