@article{a7b43109687f4fde96f45812dc1e236e,
title = "Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study",
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",
author = "{for the} and {TB: HIV study in EuroCoord} and Efsen, {A. M.W.} and A. Schultze and Miller, {R. F.} and A. Panteleev and A. Skrahin and Podlekareva, {D. N.} and Miro, {J. M.} and E. Girardi and H. Furrer and Losso, {M. H.} and J. Toibaro and Cayl{\`a}, {J. A.} and A. Mocroft and Lundgren, {J. D.} and Post, {F. A.} and O. Kirk and I. Karpov and A. Vassilenko and A. Skrahina and D. Klimuk and A. Skrahin and O. Kondratenko and A. Zalutskaya and V. Bondarenko and V. Mitsura and E. Kozorez and O. Tumash and O. Suetnov and D. Paduto and V. Iljina and T. Kummik and N. Bolokadze and K. Mshvidobadze and N. Lanchava and L. Goginashvili and L. Mikiashvili and N. Bablishvili and B. Rozentale and I. Zeltina and I. Janushkevich and I. Caplinskiene and S. Caplinskas and Z. Kancauskiene and R. Podlasin and A. Wiercinska-Drapalo and M. Thompson and J. Kozlowska and A. Grezesczuk and M. Bura and B. Knysz",
note = "Funding Information: Switzerland, Swiss HIV Cohort Study (SHCS, www.shcs.ch ): Cohorte administration: M. Sagette and M. Rickenbach. Participating Centers and Physicians: University Hospital Basel: L. Elzi and M. Battegay; University Hospital Bern: H. Furrer (PI); Hopital Cantonal Universitaire, Geneve: D. Sculier and A. Calmy; Centre Hospitalaire Universitaire Vaudois, Lausanne: M. Cavassini; Hospital of Lugano: A. Bruno and E. Bernasconi; Cantonal Hospital St. Gallen: M. Hoffmann and P. Vernazza; University Hospital Zurich: J. Fehr and Prof. R. Weber. This study has been co-financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant # 148522) and by SHCS project 666. The data are gathered by the Five Swiss University Hospitals, two Cantonal Hospitals, 15 affiliated hospitals and 36 private physicians).The members of the Swiss HIV Cohort Study are: Aubert V, Battegay M, Bernasconi E, B{\"o}ni J, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H (Chairman of the Clinical and Laboratory Committee), Fux CA, Gorgievski M, G{\"u}nthard H (President of the SHCS), Haerry D (deputy of “Positive Council”), Hasse B, Hirsch HH, Hoffmann M, H{\"o}sli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Metzner K, M{\"u}ller N, Nadal D, Nicca D, Pantaleo G, Rauch A (Chairman of the Scientific Board), Regenass S, Rickenbach M (Head of Data Center), Rudin C (Chairman of the Mother & Child Substudy), Sch{\"o}ni-Affolter F, Schmid P, Sch{\"u}pbach J, Speck R, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Funding Information: Funding: This work was supported by EU – 7th Framework (FP7/2007-2013, EuroCoord n 260694) programme. The funding source had no role in study design, the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2017 The British Infection Association",
year = "2018",
month = jan,
doi = "10.1016/j.jinf.2017.10.007",
language = "English (US)",
volume = "76",
pages = "44--54",
journal = "Journal of Infection",
issn = "0163-4453",
publisher = "W.B. Saunders Ltd",
number = "1",
}