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

Efsen, AMW; Schultze, A; Miller, RF; Panteleev, A; Skrahin, A; Podlekareva, DN; Miro, JM; ... TB: HIV study in EuroCoord, ; + view all (2018) Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study. Journal of Infection , 76 (1) pp. 44-54. 10.1016/j.jinf.2017.10.007. Green open access

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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.

Type: Article
Title: Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jinf.2017.10.007
Publisher version: https://doi.org/10.1016/j.jinf.2017.10.007
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Eastern Europe, HIV, MDR-TB, Tuberculosis
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10034572
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