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|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.|
Post, Frank A.
Miller, Robert F.
Losso, Marcelo H.
Miró Meda, José M.
Caylà i Buqueras, Joan A.
Podlekareva, Daria N.
Lundgren, Jens D.
Alcaide Fernández de Vega, Fernando
TB:HIV Study Group
Infeccions per VIH
Resistència als medicaments
Europa de l'Est
|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: http://dx.doi.org/10.1371/journal.pone.0145380|
|It is part of:||PLoS One, 2015, vol. 10, num. 12, p. e0145380|
|Appears in Collections:||Articles publicats en revistes (Patologia i Terapèutica Experimental)|
Articles publicats en revistes (Medicina)
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