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

Efsen AM, Schultze A, Post FA, Panteleev A, Furrer H, Miller RF, Losso MH, Toibaro J, Skrahin A, Miro JM, Caylà JA, Girardi E, Bruyand M, Obel N, Podlekareva DN, Lundgren JD, Mocroft A, Kirk O, TB:HIV study group in EuroCoo - PLoS ONE (2015)

Bottom Line: Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE).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.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).

View Article: PubMed Central - PubMed

Affiliation: Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases and Rheumatology, CHIP, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

ABSTRACT

Objectives: 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).

Design and methods: 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.

Results: 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).

Conclusions: 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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Proportion (95% CI) receiving RHZ-based empiric therapy (a) and proportion (95%CI) with MDR-TB (b) in different countries and study regions.The intraregional differences in the use of RHZ-based empiric anti-TB treatment are shown in relation to the observed MDR-TB prevalence.
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pone.0145380.g002: Proportion (95% CI) receiving RHZ-based empiric therapy (a) and proportion (95%CI) with MDR-TB (b) in different countries and study regions.The intraregional differences in the use of RHZ-based empiric anti-TB treatment are shown in relation to the observed MDR-TB prevalence.

Mentions: In Fig 2, intraregional differences in the use of RHZ-based empiric anti-TB treatment are shown in relation to the observed MDR-TB prevalence. We observed substantial variation in the prevalence of MDR-TB in EE, ranging from 11–56% between countries with considerable uncertainty in some countries due to the small numbers of patients. The proportion of participants who initiated RHZ-based empiric anti-TB treatment appeared similar in most countries across the four regions with the exception of two countries in EE where 54% and 74% (95% CI 48–86%) of patients received such therapy. The country in which the smallest proportion of patients received RHZ-based therapy reported among the highest prevalence of MDR-TB (40%, 95% CI 24–58%). There was no evidence of a correlation between the country-wise proportions of patients initiating RHZ-based treatment and prevalences of MDR-TB (p = 0.30 and p = 0.50 for EE and WE, respectively; analysis restricted to regions with at least three data points).


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

Efsen AM, Schultze A, Post FA, Panteleev A, Furrer H, Miller RF, Losso MH, Toibaro J, Skrahin A, Miro JM, Caylà JA, Girardi E, Bruyand M, Obel N, Podlekareva DN, Lundgren JD, Mocroft A, Kirk O, TB:HIV study group in EuroCoo - PLoS ONE (2015)

Proportion (95% CI) receiving RHZ-based empiric therapy (a) and proportion (95%CI) with MDR-TB (b) in different countries and study regions.The intraregional differences in the use of RHZ-based empiric anti-TB treatment are shown in relation to the observed MDR-TB prevalence.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4696866&req=5

pone.0145380.g002: Proportion (95% CI) receiving RHZ-based empiric therapy (a) and proportion (95%CI) with MDR-TB (b) in different countries and study regions.The intraregional differences in the use of RHZ-based empiric anti-TB treatment are shown in relation to the observed MDR-TB prevalence.
Mentions: In Fig 2, intraregional differences in the use of RHZ-based empiric anti-TB treatment are shown in relation to the observed MDR-TB prevalence. We observed substantial variation in the prevalence of MDR-TB in EE, ranging from 11–56% between countries with considerable uncertainty in some countries due to the small numbers of patients. The proportion of participants who initiated RHZ-based empiric anti-TB treatment appeared similar in most countries across the four regions with the exception of two countries in EE where 54% and 74% (95% CI 48–86%) of patients received such therapy. The country in which the smallest proportion of patients received RHZ-based therapy reported among the highest prevalence of MDR-TB (40%, 95% CI 24–58%). There was no evidence of a correlation between the country-wise proportions of patients initiating RHZ-based treatment and prevalences of MDR-TB (p = 0.30 and p = 0.50 for EE and WE, respectively; analysis restricted to regions with at least three data points).

Bottom Line: Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE).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.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).

View Article: PubMed Central - PubMed

Affiliation: Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases and Rheumatology, CHIP, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

ABSTRACT

Objectives: 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).

Design and methods: 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.

Results: 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).

Conclusions: 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.

Show MeSH
Related in: MedlinePlus