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

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, J D Lundgren, F A Post, O Kirk, TB: HIV study in EuroCoord

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalJournal of Infection
Volume76
Issue number1
DOIs
Publication statusE-pub ahead of print - Oct 27 2017

Keywords

  • Journal Article

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