S K Heysell1, O B Ogarkov2, S Zhdanova3, E Zorkaltseva4, S Shugaeva5, J Gratz1, S Vitko1, E D Savilov6, M E Koshcheyev5, E R Houpt7. 1. Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA. 2. Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation; Regional TB Prevention Dispensary, Irkutsk, Russian Federation. 3. Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation. 4. Regional TB Prevention Dispensary, Irkutsk, Russian Federation; State Medical Continuing Education Academy, Irkutsk, Russian Federation. 5. Regional TB Prevention Dispensary, Irkutsk, Russian Federation. 6. Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation; State Medical Continuing Education Academy, Irkutsk, Russian Federation. 7. <sup>*</sup>Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
Abstract
SETTING: A referral hospital for tuberculosis (TB) in Irkutsk, the Russian Federation. OBJECTIVE: To describe disease characteristics, treatment and hospital outcomes of TB-HIV (human immunodeficiency virus). DESIGN: Observational cohort of HIV-infected patients admitted for anti-tuberculosis treatment over 6 months. RESULTS: A total of 98 patients were enrolled with a median CD4 count of 147 cells/mm(3) and viral load of 205 943 copies/ml. Among patients with drug susceptibility testing (DST) results, 29 (64%) were multidrug-resistant (MDR), including 12 without previous anti-tuberculosis treatment. Nineteen patients were on antiretroviral therapy (ART) at admission, and 10 (13% ART-naïve) were started during hospitalization. Barriers to timely ART initiation included death, in-patient treatment interruption, and patient refusal. Of 96 evaluable patients, 21 (22%) died, 14 (15%) interrupted treatment, and 10 (10%) showed no microbiological or radiographic improvement. Patients with a cavitary chest X-ray (aOR 7.4, 95%CI 2.3-23.7, P = 0.001) or central nervous system disease (aOR 6.5, 95%CI 1.2-36.1, P = 0.03) were more likely to have one of these poor outcomes. CONCLUSION: High rates of MDR-TB, treatment interruption and death were found in an HIV-infected population hospitalized in Irkutsk. There are opportunities for integration of HIV and TB services to overcome barriers to timely ART initiation, increase the use of anti-tuberculosis regimens informed by second-line DST, and strengthen out-patient diagnosis and treatment networks.
SETTING: A referral hospital for tuberculosis (TB) in Irkutsk, the Russian Federation. OBJECTIVE: To describe disease characteristics, treatment and hospital outcomes of TB-HIV (human immunodeficiency virus). DESIGN: Observational cohort of HIV-infectedpatients admitted for anti-tuberculosis treatment over 6 months. RESULTS: A total of 98 patients were enrolled with a median CD4 count of 147 cells/mm(3) and viral load of 205 943 copies/ml. Among patients with drug susceptibility testing (DST) results, 29 (64%) were multidrug-resistant (MDR), including 12 without previous anti-tuberculosis treatment. Nineteen patients were on antiretroviral therapy (ART) at admission, and 10 (13% ART-naïve) were started during hospitalization. Barriers to timely ART initiation included death, in-patient treatment interruption, and patient refusal. Of 96 evaluable patients, 21 (22%) died, 14 (15%) interrupted treatment, and 10 (10%) showed no microbiological or radiographic improvement. Patients with a cavitary chest X-ray (aOR 7.4, 95%CI 2.3-23.7, P = 0.001) or central nervous system disease (aOR 6.5, 95%CI 1.2-36.1, P = 0.03) were more likely to have one of these poor outcomes. CONCLUSION: High rates of MDR-TB, treatment interruption and death were found in an HIV-infected population hospitalized in Irkutsk. There are opportunities for integration of HIV and TB services to overcome barriers to timely ART initiation, increase the use of anti-tuberculosis regimens informed by second-line DST, and strengthen out-patient diagnosis and treatment networks.
Authors: J C M Brust; N S Shah; M Scott; K Chaiyachati; M Lygizos; T L van der Merwe; S Bamber; Z Radebe; M Loveday; A P Moll; B Margot; U G Lalloo; G H Friedland; N R Gandhi Journal: Int J Tuberc Lung Dis Date: 2012-06-05 Impact factor: 2.373
Authors: Leslie Hall; Kurt P Jude; Shirley L Clark; Kim Dionne; Ryan Merson; Ana Boyer; Nicole M Parrish; Nancy L Wengenack Journal: J Clin Microbiol Date: 2012-08-15 Impact factor: 5.948
Authors: A Bobkov; E Kazennova; T Khanina; M Bobkova; L Selimova; A Kravchenko; V Pokrovsky; J Weber Journal: AIDS Res Hum Retroviruses Date: 2001-02-10 Impact factor: 2.205
Authors: Gustavo E Velásquez; Mercedes C Becerra; Irina Y Gelmanova; Alexander D Pasechnikov; Askar Yedilbayev; Sonya S Shin; Yevgeny G Andreev; Galina Yanova; Sidney S Atwood; Carole D Mitnick; Molly F Franke; Michael L Rich; Salmaan Keshavjee Journal: Clin Infect Dis Date: 2014-04-11 Impact factor: 9.079
Authors: Scott K Heysell; Shahriar Ahmed; Sara Sabrina Ferdous; Md Siddiqur Rahman Khan; S M Mazidur Rahman; Jean Gratz; Md Toufiq Rahman; Asif Mujtaba Mahmud; Eric R Houpt; Sayera Banu Journal: PLoS One Date: 2015-02-24 Impact factor: 3.240
Authors: Kwonjune J Seung; David B Omatayo; Salmaan Keshavjee; Jennifer J Furin; Paul E Farmer; Hind Satti Journal: PLoS One Date: 2009-09-25 Impact factor: 3.240
Authors: Galina Lyles; Oleg Ogarkov; Svetlana Zhdanova; Charles A Peloquin; Andrew Ebers; Herman Pfaeffle; Mohammad H Al-Shaer; Elena Moiseeva; Elena Zorkaltseva; Mikhail Koscheev; Eric R Houpt; Scott K Heysell Journal: Eur Respir J Date: 2018-05-24 Impact factor: 16.671
Authors: Devyani Deshpande; Jan-Willem C Alffenaar; Claudio U Köser; Keertan Dheda; Moti L Chapagain; Noviana Simbar; Thomas Schön; Marieke G G Sturkenboom; Helen McIlleron; Pooi S Lee; Thearith Koeuth; Stellah G Mpagama; Sayera Banu; Suporn Foongladda; Oleg Ogarkov; Suporn Pholwat; Eric R Houpt; Scott K Heysell; Tawanda Gumbo Journal: Clin Infect Dis Date: 2018-11-28 Impact factor: 9.079
Authors: O B Ogarkov; A Ebers; S Zhdanova; E Moiseeva; M E Koshcheyev; E Zorkaltseva; S Shugaeva; S Vitko; G Lyles; E R Houpt; S K Heysell Journal: Public Health Action Date: 2016-12-21
Authors: Megan E Gray Neils; Herman O I Pfaeffle; Art T Kulatti; Alena Titova; Galina S Lyles; Yulia Plotnikova; Elena Zorkaltseva; Oleg B Ogarkov; Serhiy M Vitko; Rebecca A Dillingham; Scott K Heysell Journal: Front Public Health Date: 2020-04-02