Please use this identifier to cite or link to this item:
Title: Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America
Author: Efsen, Anne Marie W.
Schultze, Anna
Post, Frank A.
Panteleev, Alexander
Furrer, Hansjakob
Miller, Robert F.
Losso, Marcelo H.
Toibaro, Javier
Skrahin, Aliaksandr
Miró Meda, José M.
Caylà i Buqueras, Joan A.
Girardi, Enrico
Bruyand, Mathias
Obel, Niels
Podlekareva, Daria N.
Lundgren, Jens D.
Mocroft, Amanda
Kirk, Ole
Alcaide Fernández de Vega, Fernando
TB:HIV study group in EuroCoord
Keywords: Tuberculosi
VIH (Virus)
Infeccions per VIH
Resistència als medicaments
Europa de l'Est
Europa occidental
Amèrica Llatina
HIV (Viruses)
HIV infections
Drug resistance
Eastern Europe
Western Europe
Latin America
Issue Date: 30-Dec-2015
Publisher: Public Library of Science (PLoS)
Abstract: Objectives: rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA). Design and methods: between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled. Results: significant differences were observed between EE (N = 844), WE (N = 152), SE (N = 164), and LA (N = 253) in the proportion of patients with a definite TB diagnosis (47%, 71%, 72% and 40%, p<0.0001), MDR-TB (40%, 5%, 3% and 15%, p<0.0001), and use of combination antiretroviral therapy (cART) (17%, 40%, 44% and 35%, p<0.0001). Injecting drug use (adjusted OR (aOR) = 2.03 (95% CI 1.00-4.09), prior anti-TB treatment (3.42 (1.88-6.22)), and living in EE (7.19 (3.28-15.78)) were associated with MDR-TB. Among 585 patients with drug susceptibility test (DST) results, the empiric (i.e. without knowledge of the DST results) anti-TB treatment included ≥3 active drugs in 66% of participants in EE compared with 90-96% in other regions (p<0.0001). Conclusions: in EE, TB/HIV patients were less likely to receive a definite TB diagnosis, more likely to house MDR-TB and commonly received empiric anti-TB treatment with reduced activity. Improved management of TB/HIV patients in EE requires better access to TB diagnostics including DSTs, empiric anti-TB therapy directed at both susceptible and MDR-TB, and more widespread use of cART.
Note: Reproducció del document publicat a:
It is part of: PLoS One, 2015, vol. 10, num. 12, p. e0145380
Related resource:
ISSN: 1932-6203
Appears in Collections:Articles publicats en revistes (Patologia i Terapèutica Experimental)
Articles publicats en revistes (Medicina)
Publicacions de projectes de recerca finançats per la UE

Files in This Item:
File Description SizeFormat 
662116.pdf871.94 kBAdobe PDFView/Open

This item is licensed under a Creative Commons License Creative Commons