A M W Efsen1, A Schultze2, R F Miller3, A Panteleev4, A Skrahin5, D N Podlekareva6, J M Miro7, E Girardi8, H Furrer9, M H Losso10, J Toibaro10, J A Caylà11, A Mocroft2, J D Lundgren6, F A Post12, O Kirk6. 1. CHIP, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark. Electronic address: anne.marie.werlinrud.efsen@regionh.dk. 2. Department of Infection and Population Health, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK. 3. Centre for Sexual Health and HIV Research, Mortimer Market Centre, University College London, London WC1E 6JB, UK. 4. Department of HIV/TB, TB hospital 2, Ushinskogo str 39/1 - 122, St. Petersburg 195267, Russia. 5. Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus. 6. CHIP, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark. 7. Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel, 170, Barcelona 08036, Spain. 8. Department of Infectious Diseases INMI "L. Spallanzani", Ospedale L Spallanzani, Via Portuense, 292, Rome 00149, Italy. 9. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland. 10. Department of immunocompromised, Hospital J.M. Ramos Mejia, Pabellón de Cliníca, 2do Piso, Buenos Aires CP 1221, Argentina. 11. Agencia de Salud Pública de Barcelona, Barcelona, Spain; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. 12. Department of Sexual Health, Caldecot Centre, King's College Hospital, Bessemer Road, London SE5 9RS, UK.
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.
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.
Authors: G Günther; F van Leth; N Altet; M Dedicoat; R Duarte; G Gualano; H Kunst; I Muylle; V Spinu; S Tiberi; P Viiklepp; C Lange Journal: Int J Tuberc Lung Dis Date: 2015-12 Impact factor: 2.373
Authors: Jens D Lundgren; Abdel G Babiker; Fred Gordin; Sean Emery; Birgit Grund; Shweta Sharma; Anchalee Avihingsanon; David A Cooper; Gerd Fätkenheuer; Josep M Llibre; Jean-Michel Molina; Paula Munderi; Mauro Schechter; Robin Wood; Karin L Klingman; Simon Collins; H Clifford Lane; Andrew N Phillips; James D Neaton Journal: N Engl J Med Date: 2015-07-20 Impact factor: 91.245
Authors: Alimuddin Zumla; Jeremiah Chakaya; Rosella Centis; Lia D'Ambrosio; Peter Mwaba; Matthew Bates; Nathan Kapata; Thomas Nyirenda; Duncan Chanda; Sayoki Mfinanga; Michael Hoelscher; Markus Maeurer; Giovanni Battista Migliori Journal: Lancet Respir Med Date: 2015-03-09 Impact factor: 30.700
Authors: Daria N Podlekareva; Alexander M Panteleev; Daniel Grint; Frank A Post; Jose M Miro; Mathias Bruyand; Hansjakob Furrer; Niels Obel; Enrico Girardi; Anna Vasilenko; Marcelo H Losso; Alejandro Arenas-Pinto; Joan Caylá; Aza Rakhmanova; Indra Zeltina; Anne Marie Werlinrud; Jens D Lundgren; Amanda Mocroft; Ole Kirk Journal: Eur Respir J Date: 2013-06-13 Impact factor: 16.671
Authors: Christian Kraef; Adrian Bentzon; Alexander Panteleev; Alena Skrahina; Natalie Bolokadze; Simona Tetradov; Regina Podlasin; Igor Karpov; Elena Borodulina; Elena Denisova; Inga Azina; Jens Lundgren; Isik Somuncu Johansen; Amanda Mocroft; Daria Podlekareva; Ole Kirk Journal: BMC Infect Dis Date: 2021-10-06 Impact factor: 3.090
Authors: Joseph Baruch Baluku; Pallen Mugabe; Rose Mulwana; Sylvia Nassozi; Richard Katuramu; William Worodria Journal: Biomed Res Int Date: 2020-07-25 Impact factor: 3.411