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Título:	Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB: HIV study
Autor/a:	Efsen, Anne Marie W.; Schultze, Anna; Miller, Robert F.; Panteleev, Alexander; Skrahin, Aliaksandr; Podlekareva, Daria N.; Miró Meda, José M.; Girardi, Enrico; Furrer, Hansjakob; Losso, Marcelo H.; Toibaro, Javier; Caylà i Buqueras, Joan A.; Mocroft, Amanda; Lundgren, Jens D.; Kirk, Ole; Post, Frank A.; Manzardo, Christian; Ligero, M. C.; González, J.; HIV study in EuroCoord
Notas:	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.
Materia(s):	-Infeccions per VIH -Tuberculosi -HIV infections -Tuberculosis
Derechos:	cc-by-nc-nd (c) The British Infection Association, 2018 http://creativecommons.org/licenses/by-nc-nd/3.0/es
Tipo de documento:	Artículo Artículo - Versión aceptada
Editor:	Elsevier
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