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

TY - JOUR

T1 - Management of MDR-TB in HIV co-infected patients in Eastern Europe

T2 - Results from the TB:HIV study

AU - Efsen, A M W

AU - Schultze, A

AU - Miller, R F

AU - Panteleev, A

AU - Skrahin, A

AU - Podlekareva, D N

AU - Miro, J M

AU - Girardi, E

AU - Furrer, H

AU - Losso, M H

AU - Toibaro, J

AU - Caylà, J A

AU - Mocroft, A

AU - Lundgren, J D

AU - Post, F A

AU - Kirk, O

AU - TB: HIV study in EuroCoord

N1 - Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

PY - 2018/1

Y1 - 2018/1

N2 - 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.

AB - 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.

U2 - 10.1016/j.jinf.2017.10.007

DO - 10.1016/j.jinf.2017.10.007

M3 - Journal article

C2 - 29061336

SN - 0163-4453

VL - 76

SP - 44

EP - 54

JO - Journal of Infection

JF - Journal of Infection

IS - 1

ER -