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

Autor: 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
Zdroj: Journal of Infection; Jan2018, Vol. 76 Issue 1, p44-54, 11p
Abstrakt: 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. [ABSTRACT FROM AUTHOR]
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