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Title:	Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB: HIV study
Author:	Efsen, A. M. W.; Schultze, A.; Miller, R. F.; Panteleev, A.; Skrahin, A.; Podlekareva, D. N.; Miró Meda, José M.; Girardi, E.; Furrer, H.; Losso, M. H.; Toibaro, J.; Caylà i Buqueras, Joan A.; Mocroft, A.; Lundgren, J. D.; Kirk, O.; Post, F. A.; Manzardo, Christian; Ligero, C.; González, J.; HIV study in EuroCoord
Other authors:	Universitat de Barcelona
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.
Subject(s):	-Infeccions per VIH -Tuberculosi -HIV infections -Tuberculosis
Rights:	cc-by-nc-nd (c) The British Infection Association, 2018 http://creativecommons.org/licenses/by-nc-nd/3.0/es
Document type:	Article Article - Accepted version
Published by:	Elsevier
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