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

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 th...

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Detalles Bibliográficos
Publicado: 2018
Materias:
Eastern Europe
HIV
MDR-TB
Tuberculosis
aminosalicylic acid
cycloserine
ethambutol
ethionamide
isoniazid
protionamide
pyrazinamide
quinoline derived antiinfective agent
rifampicin
streptomycin
terizidone
virus RNA
adult
antiretroviral therapy
Article
cohort analysis
drug efficacy
female
follow up
human
Human immunodeficiency virus infection
infection sensitivity
major clinical study
male
mixed infection
multidrug resistant tuberculosis
patient care
patient monitoring
prospective study
treatment outcome
virus load
Acceso en línea:https://bibliotecadigital.exactas.uba.ar/collection/paper/document/paper_01634453_v76_n1_p44_Efsen
http://hdl.handle.net/20.500.12110/paper_01634453_v76_n1_p44_Efsen
Aporte de:
Biblioteca Digital - Facultad de Ciencias Exactas y Naturales (UBA) de Universidad de Buenos Aires
Descripción
Sumario: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. © 2017 The British Infection Association

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