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Title: | Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB: HIV study |
Author: | Efsen, Anne Marie W. Schultze, Anna Miller, Robert F. Panteleev, Alexander Skrahin, Aliaksandr Podlekareva, Daria N. Miró Meda, José M. Girardi, Enrico Furrer, Hansjakob Losso, Marcelo H. Toibaro, Javier Caylà i Buqueras, Joan A. Mocroft, Amanda Lundgren, Jens D. Kirk, Ole Post, Frank A. Manzardo, Christian Ligero, M. C. González, J. HIV study in EuroCoord |
Keywords: | Infeccions per VIH Tuberculosi HIV infections Tuberculosis |
Issue Date: | Jan-2018 |
Publisher: | Elsevier |
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. |
Note: | Versió postprint del document publicat a: https://doi.org/10.1016/j.jinf.2017.10.007 |
It is part of: | Journal of Infection, 2018, vol. 76, num. 1, p. 44-54 |
URI: | http://hdl.handle.net/2445/131299 |
Related resource: | https://doi.org/10.1016/j.jinf.2017.10.007 |
ISSN: | 0163-4453 |
Appears in Collections: | Articles publicats en revistes (Medicina) Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) |
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