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HIV Med. 2018 May;19(5):316-323. doi: 10.1111/hiv.12576. Epub 2018 Feb 21.

Increasing incidence of HIV- associated tuberculosis in Romanian injecting drug users.

Author information

1
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
2
Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania.
3
Laboratory of Bacteriology, Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania.
4
Stefan S. Nicolau Institute of Virology, Bucharest, Romania.
5
Institute of Global Health, University College London, London, UK.
6
Royal Free London NHS Foundation Trust, London, UK.
7
UCL Respiratory, Division of Medicine, University College London, London, UK.

Abstract

BACKGROUND:

A high prevalence of tuberculosis (TB) among HIV-positive injecting drug users (IDUs) may fuel the TB epidemic in the general population of Romania. We determined the frequency and characteristics of TB in HIV-infected IDUs referred to a national centre.

METHODS:

Prospective observational cohort study of all newly-diagnosed HIV-positive IDUs admitted to Victor Babes Hospital, Bucharest, between January 2009 and December 2014. Socio-demographics, clinical characteristics and outcomes of HIV/TB co-infected IDUs were compared to HIV-positive IDUs without TB.

RESULTS:

170/598 (28.5%) HIV-infected IDUs were diagnosed with TB. The prevalence increased from 12.5% in 2009 to 32.1% in 2014 (P < 0.001). HIV/TB co-infected individuals had lower median CD4 cell counts 75 (vs. 450/mm3 , P < 0.0001) and higher median HIV viral loads 5.6 log10 (vs. 4.9 log10 , P < 0.0001) when presenting to healthcare services. 103/170 (60.6%) HIV/TB co-infected IDUs were diagnosed with pulmonary TB. Resistant Mycobacterium tuberculosis strains were common, with 18/105 (17.1%) of patients having Multi-Drug Resistant (MDR) disease. Higher mortality rate was associated with TB co-infection (P < 0.0001), extra-pulmonary TB (P = 0.0026) and extensively drug resistant TB (P = 0.024).

CONCLUSIONS:

Tuberculosis (TB) is an increasing problem in HIV-infected IDUs in Romania. Presentation is often with advanced HIV, significant TB drug resistance and consequent outcomes are poor.

KEYWORDS:

HIV infection; injecting drug users; prevalence; survival; tuberculosis

PMID:
29464834
DOI:
10.1111/hiv.12576

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