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. 2018 Jan;76(1):44-54.
doi: 10.1016/j.jinf.2017.10.007. Epub 2017 Oct 20.

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

A M W Efsen  1 , A Schultze  2 , R F Miller  3 , A Panteleev  4 , A Skrahin  5 , D N Podlekareva  6 , J M Miro  7 , E Girardi  8 , H Furrer  9 , M H Losso  10 , J Toibaro  10 , J A Caylà  11 , A Mocroft  2 , J D Lundgren  6 , F A Post  12 , O Kirk  6 ; TB: HIV study in EuroCoord
Collaborators, Affiliations

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

A M W Efsen et al. J Infect. 2018 Jan.

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.

Keywords: Eastern Europe; HIV; MDR-TB; Tuberculosis.

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Figures

Figure 1
Figure 1
TB treatment and outcomes over time among 105 patients with MDR-TB (left), 183 with no DST (middle) and 130 patients with susceptible TB (right) from time of start of TB treatment. R = Rifampicin H = Isoniazid Z = Pyrazinamide E = Ethambutol S = Streptomycin FQ = Fluoroquinolone 2L-inj = Second-line injectables LTFU = Loss to follow-up DST = Drug-susceptibility test
Figure 2
Figure 2
a-c: Number of total TB drugs (a), potentially active* (b), and known active** (c) TB drugs at each time point for 105 MDR-TB patients under follow-up. *Potentially active: Assuming susceptibility where DST for a specific drug was missing. **Known active: Only including known DST results and not assuming susceptibility for missing DST.
Figure 3
Figure 3
Antiretroviral (ART) status over time for MDR-TB patients (N = 105)* *ART and viral load (VL) was calculated +/− 1 month of the various time-points.
See this image and copyright information in PMC

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