Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study
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Management of MDR-TB in HIV co-infected patients in Eastern Europe : Results from the TB:HIV study. / Efsen, A M W; Schultze, A; Miller, R F; Panteleev, A; Skrahin, A; Podlekareva, D N; Miro, J M; Girardi, E; Furrer, H; Losso, M H; Toibaro, J; Caylà, J A; Mocroft, A; Lundgren, J D; Post, F A; Kirk, O; TB: HIV study in EuroCoord.
I: Journal of Infection, Bind 76, Nr. 1, 2018, s. 44-54.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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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
Y1 - 2018
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
VL - 76
SP - 44
EP - 54
JO - Journal of Infection
JF - Journal of Infection
SN - 0163-4453
IS - 1
ER -
ID: 194651774