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

2017; Elsevier BV; Volume: 76; Issue: 1 Linguagem: Inglês

10.1016/j.jinf.2017.10.007

1532-2742

Anne Marie W. Efsen, Anna Schultze, Robert F. Miller, Alexander Panteleev, Aliaksandr Skrahin, Daria Podlekareva, José M. Miró, Enrico Girardi, Hansjakob Furrer, Marcelo H. Losso, Javier Toibaro, Joan A. Caylà, Amanda Mocroft, Jens Lundgren, Frank A. Post, Ole Kirk, Igor Karpov, Anna Vassilenko, Aliaksandr Skrahin, Dzmitry Klimuk, Aliaksandr Skrahin, О. В. Кондратенко, Aksana Zalutskaya, В. Н. Бондаренко, В. М. Мицура, Е. И. Козорез, О. Л. Тумаш, O. Suetnov, D. Paduto, V. Iljina, Tiina Kummik, N Bolokadze, Ketevan Mshvidobadze, N. Lanchava, Leila Goginashvili, Lali Mikiashvili, Nino Bablishvili, Baiba Rozentāle, Indra Zeltiņa, I. Janushkevich, Irma Čaplinskienė, Saulius Čaplinskas, Zavinta Kancauskiene, Regina Podlasin, Alicja Wiercińska‐Drapało, M. Thompson, Joanna Kozłowska, A. Grezesczuk, Maciej Bura, Brygida Knysz, Małgorzata Inglot, Aleksander Garlicki, Jolanta Loster, Simona Tetradov, Dan Duiculescu, Aza Rakhmanova, Ольга Викторовна Пантелеева, A.A. Yakovlev, А. Е. Козлов, A. Tyukalova, Yu. Yu. Vlasova, Alexander Panteleev, T. Trofimov, Galyna Kyselyova, Åse Bengård Andersen, Kristina Thorsteinsson, M.C. Payen, Kabamba Kabeya, Coca Necsoi, François Dabis, Mathias Bruyand, P Morlat, A. Dupont, Y Gérard, F. Bonnal, J. Ceccaldi, S Witte, É. Monlun, P. Lataste, I. Chossat, Robert F. Miller, Nina Vora, Graham Cooke, Scott Mullaney, E. Wilkins, Varghese George, Paul Collini, David H. Dockrell, Frank A. Post, Lucy Campbell, Ricardo Brum, E. Mabonga, Priyanka Saigal, Stephen Kegg, Jonathan Ainsworth, A. Waters, Jyoti Dhar, L. Mashonganyika, Enrico Girardi, Alessia Rianda, Vincenzo Galati, Carmela Pinnetti, Chiara Tommasi, Giuseppe Lapadula, Antonio Di Biagio, Andrea Parisini, Santa Carbonara, Gioacchino Angarano, M. Purgatorio, Alberto Matteelli, A. Apostoli, Javier Toibaro, L. Moreno Macias, Eduardo Warley, Silvina Tavella, Oscar García Messina, O. Gear, H. Laplume, C. Marson, J. Contarelia, M.G. Michaan, Pablo Scapellato, Daniela D ́Alessandro, B. Bartoletti, Domingo Palmero, Carlos del Ojo Elías, Claudia P. Cortés, Brenda Crabtree, Juan Luis Mosqueda-Gómez, A. V. Villanueva, L. A. Gonzalez Hernandez,

Tuberculosis Research and Epidemiology

Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce.In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART).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%.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.