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

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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

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Eastern Europe
Multidrug-Resistant Tuberculosis
Tuberculosis
HIV
Therapeutics
Virus Integration
Viral Load
Drug Resistance
Prospective Studies
RNA
Delivery of Health Care

Keywords

  • Journal Article

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Efsen, A. M. W., Schultze, A., Miller, R. F., Panteleev, A., Skrahin, A., Podlekareva, D. N., ... TB: HIV study in EuroCoord (2017). Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study. Journal of Infection, 76(1), 1-11. https://doi.org/10.1016/j.jinf.2017.10.007

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.

In: Journal of Infection, Vol. 76, No. 1, 27.10.2017, p. 1-11.

Research output: Contribution to journalArticle

Efsen, AMW, Schultze, A, Miller, RF, Panteleev, A, Skrahin, A, Podlekareva, DN, Miro, JM, Girardi, E, Furrer, H, Losso, MH, Toibaro, J, Caylà, JA, Mocroft, A, Lundgren, JD, Post, FA, Kirk, O & TB: HIV study in EuroCoord 2017, 'Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study', Journal of Infection, vol. 76, no. 1, pp. 1-11. https://doi.org/10.1016/j.jinf.2017.10.007
Efsen AMW, Schultze A, Miller RF, Panteleev A, Skrahin A, Podlekareva DN et al. Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study. Journal of Infection. 2017 Oct 27;76(1):1-11. https://doi.org/10.1016/j.jinf.2017.10.007
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. / Management of MDR-TB in HIV co-infected patients in Eastern Europe : Results from the TB:HIV study. In: Journal of Infection. 2017 ; Vol. 76, No. 1. pp. 1-11.
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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 - 2017/10/27

Y1 - 2017/10/27

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.

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JF - Journal of Infection

SN - 0163-4453

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