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

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

In: Journal of Infection, Vol. 76, No. 1, 01.2018, p. 44-54.

Research output: Contribution to journal › Article › peer-review

BibTeX

@article{c8817df63362464ebf7c47dca74da1bb,

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

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",

author = "{TB:HIV Study Group} and Efsen, {A. M.W.} and A. Schultze and Miller, {R. F.} and A. Panteleev and A. Skrahin and Podlekareva, {D. N.} and Miro, {J. M.} and E. Girardi and H. Furrer and Losso, {M. H.} and J. Toibaro and Cayl{\`a}, {J. A.} and A. Mocroft and Lundgren, {J. D.} and Post, {F. A.} and O. Kirk and I. Karpov and A. Vassilenko and A. Skrahina and D. Klimuk and A. Skrahin and O. Kondratenko and A. Zalutskaya and V. Bondarenko and V. Mitsura and E. Kozorez and O. Tumash and O. Suetnov and D. Paduto and V. Iljina and T. Kummik and N. Bolokadze and K. Mshvidobadze and N. Lanchava and L. Goginashvili and L. Mikiashvili and N. Bablishvili and B. Rozentale and I. Zeltina and I. Janushkevich and I. Caplinskiene and S. Caplinskas and Z. Kancauskiene and R. Podlasin and A. Wiercinska-Drapalo and A. Rakhmanova and O. Panteleeva and A. Yakovlev and A. Kozlov and A. Panteleev",

year = "2018",

month = jan,

doi = "10.1016/j.jinf.2017.10.007",

language = "English",

volume = "76",

pages = "44--54",

journal = "Journal of Infection",

issn = "0163-4453",

publisher = "W.B. Saunders Ltd",

number = "1",

}

RIS

TY - JOUR

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

T2 - Results from the TB:HIV study

AU - TB:HIV Study Group

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 - Karpov, I.

AU - Vassilenko, A.

AU - Skrahina, A.

AU - Klimuk, D.

AU - Skrahin, A.

AU - Kondratenko, O.

AU - Zalutskaya, A.

AU - Bondarenko, V.

AU - Mitsura, V.

AU - Kozorez, E.

AU - Tumash, O.

AU - Suetnov, O.

AU - Paduto, D.

AU - Iljina, V.

AU - Kummik, T.

AU - Bolokadze, N.

AU - Mshvidobadze, K.

AU - Lanchava, N.

AU - Goginashvili, L.

AU - Mikiashvili, L.

AU - Bablishvili, N.

AU - Rozentale, B.

AU - Zeltina, I.

AU - Janushkevich, I.

AU - Caplinskiene, I.

AU - Caplinskas, S.

AU - Kancauskiene, Z.

AU - Podlasin, R.

AU - Wiercinska-Drapalo, A.

AU - Rakhmanova, A.

AU - Panteleeva, O.

AU - Yakovlev, A.

AU - Kozlov, A.

AU - Panteleev, A.

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.

KW - Eastern Europe

KW - HIV

KW - MDR-TB

KW - Tuberculosis

UR - http://www.scopus.com/inward/record.url?scp=85032918910&partnerID=8YFLogxK

U2 - 10.1016/j.jinf.2017.10.007

DO - 10.1016/j.jinf.2017.10.007

M3 - Article

C2 - 29061336

AN - SCOPUS:85032918910

VL - 76

SP - 44

EP - 54

JO - Journal of Infection

JF - Journal of Infection

SN - 0163-4453

IS - 1

ER -

ID: 76678586

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

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