Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America

Anne Marie W Efsen; Anna Schultze; Frank A Post; Alexander Panteleev; Hansjakob Furrer; Robert F Miller; Marcelo H Losso; Javier Toibaro; Aliaksandr Skrahin; Jose M Miro; Joan A Caylà; Enrico Girardi; Mathias Bruyand; Niels Obel; Daria N Podlekareva; Jens D Lundgren; Amanda Mocroft; Ole Kirk; TB:HIV study group in EuroCoord

doi:10.1371/journal.pone.0145380

Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America

Anne Marie W Efsen, Anna Schultze, Frank A Post, Alexander Panteleev, Hansjakob Furrer, Robert F Miller, Marcelo H Losso, Javier Toibaro, Aliaksandr Skrahin, Jose M Miro, Joan A Caylà, Enrico Girardi, Mathias Bruyand, Niels Obel, Daria N Podlekareva, Jens D Lundgren, Amanda Mocroft, Ole Kirk, TB:HIV study group in EuroCoord

Department of Clinical Medicine

19 Citations (Scopus)

Abstract

Objectives: Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE).We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA). Design and Methods: Between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled. Results: Significant differences were observed between EE (N = 844), WE (N = 152), SE (N = 164), and LA (N = 253) in the proportion of patients with a definite TB diagnosis (47%, 71%, 72% and 40%, p<0.0001), MDR-TB (40%, 5%, 3% and 15%, p<0.0001), and use of combination antiretroviral therapy (cART) (17%, 40%, 44% and 35%, p<0.0001). Injecting drug use (adjusted OR (aOR) = 2.03 (95% CI 1.00-4.09), prior anti-TB treatment (3.42 (1.88-6.22)), and living in EE (7.19 (3.28-15.78)) were associated with MDR-TB. Among 585 patients with drug susceptibility test (DST) results, the empiric (i.e. without knowledge of the DST results) anti-TB treatment included ≥3 active drugs in 66% of participants in EE compared with 90-96% in other regions (p<0.0001). Conclusions: In EE, TB/HIV patients were less likely to receive a definite TB diagnosis, more likely to house MDR-TB and commonly received empiric anti-TB treatment with reduced activity. Improved management of TB/HIV patients in EE requires better access to TB diagnostics including DSTs, empiric anti-TB therapy directed at both susceptible and MDR-TB, and more widespread use of cART.

Original language	English
Article number	e0145380
Journal	P L o S One
Volume	10
Issue number	12
Pages (from-to)	1-17
Number of pages	17
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0145380
Publication status	Published - 1 Dec 2015

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Efsen, A. M. W., Schultze, A., Post, F. A., Panteleev, A., Furrer, H., Miller, R. F., Losso, M. H., Toibaro, J., Skrahin, A., Miro, J. M., Caylà, J. A., Girardi, E., Bruyand, M., Obel, N., Podlekareva, D. N., Lundgren, J. D., Mocroft, A., Kirk, O., & TB:HIV study group in EuroCoord (2015). Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America. P L o S One, 10(12), 1-17. Article e0145380. https://doi.org/10.1371/journal.pone.0145380

Efsen, AMW, Schultze, A, Post, FA, Panteleev, A, Furrer, H, Miller, RF, Losso, MH, Toibaro, J, Skrahin, A, Miro, JM, Caylà, JA, Girardi, E, Bruyand, M, Obel, N, Podlekareva, DN, Lundgren, JD, Mocroft, A, Kirk, O & TB:HIV study group in EuroCoord 2015, 'Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America', P L o S One, vol. 10, no. 12, e0145380, pp. 1-17. https://doi.org/10.1371/journal.pone.0145380

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title = "Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America",

abstract = "Objectives: Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE).We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA). Design and Methods: Between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled. Results: Significant differences were observed between EE (N = 844), WE (N = 152), SE (N = 164), and LA (N = 253) in the proportion of patients with a definite TB diagnosis (47%, 71%, 72% and 40%, p<0.0001), MDR-TB (40%, 5%, 3% and 15%, p<0.0001), and use of combination antiretroviral therapy (cART) (17%, 40%, 44% and 35%, p<0.0001). Injecting drug use (adjusted OR (aOR) = 2.03 (95% CI 1.00-4.09), prior anti-TB treatment (3.42 (1.88-6.22)), and living in EE (7.19 (3.28-15.78)) were associated with MDR-TB. Among 585 patients with drug susceptibility test (DST) results, the empiric (i.e. without knowledge of the DST results) anti-TB treatment included ≥3 active drugs in 66% of participants in EE compared with 90-96% in other regions (p<0.0001). Conclusions: In EE, TB/HIV patients were less likely to receive a definite TB diagnosis, more likely to house MDR-TB and commonly received empiric anti-TB treatment with reduced activity. Improved management of TB/HIV patients in EE requires better access to TB diagnostics including DSTs, empiric anti-TB therapy directed at both susceptible and MDR-TB, and more widespread use of cART.",

author = "Efsen, {Anne Marie W} and Anna Schultze and Post, {Frank A} and Alexander Panteleev and Hansjakob Furrer and Miller, {Robert F} and Losso, {Marcelo H} and Javier Toibaro and Aliaksandr Skrahin and Miro, {Jose M} and Cayl{\`a}, {Joan A} and Enrico Girardi and Mathias Bruyand and Niels Obel and Podlekareva, {Daria N} and Lundgren, {Jens D} and Amanda Mocroft and Ole Kirk and {TB:HIV study group in EuroCoord}",

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T1 - Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America

AU - Efsen, Anne Marie W

AU - Schultze, Anna

AU - Post, Frank A

AU - Panteleev, Alexander

AU - Furrer, Hansjakob

AU - Miller, Robert F

AU - Losso, Marcelo H

AU - Toibaro, Javier

AU - Skrahin, Aliaksandr

AU - Miro, Jose M

AU - Caylà, Joan A

AU - Girardi, Enrico

AU - Bruyand, Mathias

AU - Obel, Niels

AU - Podlekareva, Daria N

AU - Lundgren, Jens D

AU - Mocroft, Amanda

AU - Kirk, Ole

AU - TB:HIV study group in EuroCoord

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Objectives: Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE).We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA). Design and Methods: Between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled. Results: Significant differences were observed between EE (N = 844), WE (N = 152), SE (N = 164), and LA (N = 253) in the proportion of patients with a definite TB diagnosis (47%, 71%, 72% and 40%, p<0.0001), MDR-TB (40%, 5%, 3% and 15%, p<0.0001), and use of combination antiretroviral therapy (cART) (17%, 40%, 44% and 35%, p<0.0001). Injecting drug use (adjusted OR (aOR) = 2.03 (95% CI 1.00-4.09), prior anti-TB treatment (3.42 (1.88-6.22)), and living in EE (7.19 (3.28-15.78)) were associated with MDR-TB. Among 585 patients with drug susceptibility test (DST) results, the empiric (i.e. without knowledge of the DST results) anti-TB treatment included ≥3 active drugs in 66% of participants in EE compared with 90-96% in other regions (p<0.0001). Conclusions: In EE, TB/HIV patients were less likely to receive a definite TB diagnosis, more likely to house MDR-TB and commonly received empiric anti-TB treatment with reduced activity. Improved management of TB/HIV patients in EE requires better access to TB diagnostics including DSTs, empiric anti-TB therapy directed at both susceptible and MDR-TB, and more widespread use of cART.

AB - Objectives: Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE).We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA). Design and Methods: Between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled. Results: Significant differences were observed between EE (N = 844), WE (N = 152), SE (N = 164), and LA (N = 253) in the proportion of patients with a definite TB diagnosis (47%, 71%, 72% and 40%, p<0.0001), MDR-TB (40%, 5%, 3% and 15%, p<0.0001), and use of combination antiretroviral therapy (cART) (17%, 40%, 44% and 35%, p<0.0001). Injecting drug use (adjusted OR (aOR) = 2.03 (95% CI 1.00-4.09), prior anti-TB treatment (3.42 (1.88-6.22)), and living in EE (7.19 (3.28-15.78)) were associated with MDR-TB. Among 585 patients with drug susceptibility test (DST) results, the empiric (i.e. without knowledge of the DST results) anti-TB treatment included ≥3 active drugs in 66% of participants in EE compared with 90-96% in other regions (p<0.0001). Conclusions: In EE, TB/HIV patients were less likely to receive a definite TB diagnosis, more likely to house MDR-TB and commonly received empiric anti-TB treatment with reduced activity. Improved management of TB/HIV patients in EE requires better access to TB diagnostics including DSTs, empiric anti-TB therapy directed at both susceptible and MDR-TB, and more widespread use of cART.

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DO - 10.1371/journal.pone.0145380

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SN - 1932-6203

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JO - P L o S One

JF - P L o S One

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M1 - e0145380

ER -

Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America

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