Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study - 20/12/17
Doi : 10.1016/j.jinf.2017.10.007
A.M.W. Efsen a, * 
, A. Schultze b, R.F. Miller c, A. Panteleev d, A. Skrahin e, D.N. Podlekareva a, J.M. Miro f, E. Girardi g, H. Furrer h, M.H. Losso i, J. Toibaro i, J.A. Caylà j, k, l, A. Mocroft b, J.D. Lundgren a, F.A. Post m, O. Kirk a
for the
, A. Schultze b, R.F. Miller c, A. Panteleev d, A. Skrahin e, D.N. Podlekareva a, J.M. Miro f, E. Girardi g, H. Furrer h, M.H. Losso i, J. Toibaro i, J.A. Caylà j, k, l, A. Mocroft b, J.D. Lundgren a, F.A. Post m, O. Kirk afor the
TB: HIV study in EuroCoord1
I. Karpov 1, A. Vassilenko 1, A. Skrahina 2, D. Klimuk 2, A. Skrahin 2, O. Kondratenko 2, A. Zalutskaya 2, V. Bondarenko 3, V. Mitsura 3, E. Kozorez 3, O. Tumash 3, O. Suetnov 4, D. Paduto 4, V. Iljina 5, T. Kummik 5, N. Bolokadze 6, K. Mshvidobadze 6, N. Lanchava 6, L. Goginashvili 7, L. Mikiashvili 7, N. Bablishvili 7, B. Rozentale 8, I. Zeltina 8, I. Janushkevich 8, I. Caplinskiene 9, S. Caplinskas 9, Z. Kancauskiene 9, R. Podlasin 10, A. Wiercinska-Drapalo 10, M. Thompson 10, J. Kozlowska 10, A. Grezesczuk 11, M. Bura 12, B. Knysz 13, M. Inglot 13, A. Garlicki 14, J. Loster 14, S. Tetradov 15, D. Duiculescu 15, A. Rakhmanova 16, O. Panteleeva 16, A. Yakovlev 16, A. Kozlov 16, A. Tyukalova 16, Y. Vlasova 16, A. Panteleev 17, T. Trofimov 18, G. Kyselyova 19, A.B. Andersen 20, K. Thorsteinsson 21, M.C. Payen 22, K. Kabeya 22, C. Necsoi 22, F. Dabis 23, M. Bruyand 23, P. Morlat 24, A. Dupont 25, Y. Gerard 26, F. Bonnal 27, J. Ceccaldi 28, S. De Witte 29, E. Monlun 30, P. Lataste 31, I. Chossat 32, R. Miller 33, N. Vora 33, G. Cooke 34, S. Mullaney 34, E. Wilkins 35, V. George 35, P. Collini 36, D. Dockrell 36, F. Post 37, L. Campbell 37, R. Brum 37, E. Mabonga 37, P. Saigal 37, S. Kegg 38, J. Ainsworth 39, A. Waters 39, J. Dhar 40, L. Mashonganyika 40, E. Girardi 41, A. Rianda 41, V. Galati 41, C. Pinnetti 41, C. Tommasi 41, G. Lapadula 42, A. Di Biagio 43, A. Parisini 43, S. Carbonara 44, G. Angarano 44, M. Purgatorio 44, A. Matteelli 45, A. Apostoli 45, J. Toibaro 46, L. Moreno Macias 46, E. Warley 47, S. Tavella 47, O. Garcia Messina 48, O. Gear 48, H. Laplume 49, C. Marson 50, J. Contarelia 51, M. Michaan 51, P. Scapellato 52, D.D. Alessandro 52, B. Bartoletti 53, D. Palmero 53, C. Elias 54, C. Cortes 55, B. Crabtree 56, J.L. Mosqueda Gomez 57, A. Villanueva 58, L.A. Gonzalez Hernandez 58
1 Belarusian State Medical University, Department of Infectious Disease, Belarus
2 Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus
3 Gomel State Medical University, Gomel, Belarus
4 Gomel Region Centre for Hygiene, Belarus
5 East Viru Central Hospital, Kohtla-Jarve, Estonia
6 Infectious Diseases, AIDS and Clinical Immunology Research Center, Tiblisi, Georgia
7 National Center for Tuberculosis and Lung Diseases of Georgia, Tibilisi, Georgia
8 Infectology Centre of Latvia, Riga, Latvia
9 Centre for Communicable Diseases and AIDS, Vilnius, Lithuania
10 Wojewodski Szpital Zakanzy/Medical University of Warsaw, Warszawa, Poland
11 Wojewodski Szpital Specjalistyczny/Medical University Teaching Hospital, Bialystok, Poland
12 Jozef Strus Multidisciplinary City Hospital, Poznan, Poland
13 Wroclaw University School of Medicine, Wroclaw, Poland
14 Jagiellonian University Medical College, Krakow, Poland
15 Dr. Victor Babes Hospital, Bucharest, Romania
16 Botkin Hospital of Infectious Diseases, St. Petersburg, Russia
17 City TB Hospital No. 2, St. Petersburg, Russia
18 Center for Prevention and Control of AIDS, Veliky Novgorod, Russia
19 Crimean Republican AIDS Centre, Simferopol, Ukraine
20 Rigshospitalet, Copenhagen, Denmark
21 Hvidovre University Hospital, Denmark
22 CHU Saint-Pierre, Brussels, Belgium
23 Aquitaine Cohort, Cohort Administration, France
24 Bordeaux University Hospital, France
25 Arcachon Hospital, France
26 Dax Hospital, France
27 Bayonne Hospital, France
28 Libourne Hospital, France
29 Mont-de-Marsan Hospital, France
30 Pau Hospital, France
31 Périgueux Hospital, France
32 Villeneuve-sur-Lot Hospital, France
33 Mortimer Market Centre, London, United Kingdom
34 St. Mary's Hospital, United Kingdom
35 North Manchester General Hospital, United Kingdom
36 Sheffield Teaching Hospitals, United Kingdom
37 King's College Hospital, London, United Kingdom
38 Queen Elizabeth Hospital, United Kingdom
39 North Middlesex University Hospital, United Kingdom
40 Leicester Royal Infirmary, United Kingdom
41 IRCCS– Ospedale L. Spallanzani, Rome, Italy
42 AO San Gerardo, Monza, Italy
43 IRCCS AOU San Martino – IST di Genoa, Genova, Italy
44 Clinic of Infectious Diseases, University of Bari, Bari, Italy
45 University of Brescia Spedali Civili, Italy
46 Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
47 Hospital Paroissien, Buenos Aires, Argentina
48 Hospital Piñero, Buenos Aires, Argentina
49 Hospital Nacional Profesor Alejandro Posadas, Argentina
50 Hospital Rawson, Cordoba, Argentina
51 Hospital San Juan de Dios, La Plata, Argentina
52 Hospital General de Agudos Donación F. Santojani, Argentina
53 Hospital Francisco Javier Muñiz, Buenos Aires, Argentina
54 Hospital Jujuy, Argentina
55 Fundación Arriaran, Santiago, Chile
56 INNcMZS, México DF, Mexico
57 Hospital General Regional de Leon- CAPACITS, Mexico
58 Hospital Civil de Guadalajara, Mexico
a CHIP, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
b Department of Infection and Population Health, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK
c Centre for Sexual Health and HIV Research, Mortimer Market Centre, University College London, London WC1E 6JB, UK
d Department of HIV/TB, TB hospital 2, Ushinskogo str 39/1 – 122, St. Petersburg 195267, Russia
e Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus
f Infectious Diseases Service, Hospital Clinic – IDIBAPS, University of Barcelona, Villarroel, 170, Barcelona 08036, Spain
g Department of Infectious Diseases INMI “L. Spallanzani”, Ospedale L Spallanzani, Via Portuense, 292, Rome 00149, Italy
h Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
i Department of immunocompromised, Hospital J.M. Ramos Mejia, Pabellón de Cliníca, 2do Piso, Buenos Aires CP 1221, Argentina
j Agencia de Salud Pública de Barcelona, Barcelona, Spain
k Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB), Barcelona, Spain
l Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
m Department of Sexual Health, Caldecot Centre, King's College Hospital, Bessemer Road, London SE5 9RS, UK
*Corresponding author. Rigshospitalet, University of Copenhagen, CHIP, Department of Infectious Diseases, Section 2100 (CHIP), Blegdamsvej 9, Copenhagen DK-2100, Denmark.RigshospitaletUniversity of CopenhagenCHIPDepartment of Infectious DiseasesSection 2100 (CHIP)Blegdamsvej 9CopenhagenDK-2100Denmark
Highlights |
• | Management of TB/HIV co-infected patients in Eastern Europe (EE) is suboptimal. |
• | TB/HIV co-infected patients diagnosed with MDR-TB received inferior TB treatment with limited numbers of active drugs. |
• | Access to rapid diagnostics for TB is urgently needed. |
• | Performance of extended DST for all patients diagnosed with MDR-TB is required. |
• | Integration of TB and HIV clinics can potentially ensure better management of patients in EE. |
Summary |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Tuberculosis, HIV, MDR-TB, Eastern Europe
Plan
| Conference presentation |
|
| The results from this study were presented as a poster at the TB2016 conference, 16–17 July, Durban, South Africa (www.tb2016.org). Poster “Management of TB/HIV Co-infected Patients Including MDR-TB in Eastern Europe: Results from the TB:HIV Study”, number: P37. |
© 2017
The British Infection Association. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 76 - N° 1
P. 44-54 - janvier 2018 Retour au numéro
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