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Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Efsen Anne Marie W, Schultze Anna, Post Frank A, Panteleev Alexander, Furrer Hansjakob, Miller Robert F, Losso Marcelo H, Toibaro Javier, Skrahin Aliaksandr, Miro Jose M, Caylà Joan A, Girardi Enrico, Bruyand Mathias, Obel Niels, Podlekareva Daria N, Lundgren Jens D, Mocroft Amanda, Kirk Ole,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal PloS one
Volume (Issue) 10(12)
Page(s) 0145380 - 0145380
Title of proceedings PloS one
DOI 10.1371/journal.pone.0145380

Open Access

URL http://doi.org/10.1371/journal.pone.0145380
Type of Open Access Publisher (Gold Open Access)

Abstract

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). 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. 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). 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.
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