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

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • A M W Efsen
  • A Schultze
  • R F Miller
  • A Panteleev
  • A Skrahin
  • D N Podlekareva
  • J M Miro
  • E Girardi
  • H Furrer
  • M H Losso
  • J Toibaro
  • J A Caylà
  • A Mocroft
  • Lundgren, Jens
  • F A Post
  • Kirk, Ole
  • TB: HIV study in EuroCoord

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.

TidsskriftJournal of Infection
Udgave nummer1
Sider (fra-til)44-54
StatusUdgivet - 2018

ID: 194651774