Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America

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...

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Authors: Efsen, Anne Marie W., Schultze, Anna, Post, Frank A., Panteleev, Alexander, Furrer, Hansjakob, Miller, Robert F., Losso, Marcelo H., Toibaro, Javier, Skrahin, Aliaksandr, Miró Meda, José M. (José María), 1956-, Caylà i Buqueras, Joan A., Girardi, Enrico, Bruyand, Mathias, Obel, Niels, Podlekareva, Daria N., Lundgren, Jens D., Mocroft, Amanda, Kirk, Ole, Alcaide Fernández de Vega, Fernando, TB:HIV study group in EuroCoord
Format: article
Status:Published version
Publication Date:2015
Country:España
Institution:Universidad de Barcelona
Repository:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/99640
Online Access:https://hdl.handle.net/2445/99640
Access Level:Open access
Keyword:Tuberculosi
VIH (Virus)
Infeccions per VIH
Resistència als medicaments
Terapèutica
Europa de l'Est
Europa occidental
Amèrica Llatina
Tuberculosis
HIV (Viruses)
HIV infections
Drug resistance
Therapeutics
Eastern Europe
Western Europe
Latin America
id ES_4a71a210f3dc87dbdc9c98e6bf4ceba5
oai_identifier_str oai:diposit.ub.edu:2445/99640
network_acronym_str ES
network_name_str España
repository_id_str
spelling Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin AmericaEfsen, Anne Marie W.Schultze, AnnaPost, Frank A.Panteleev, AlexanderFurrer, HansjakobMiller, Robert F.Losso, Marcelo H.Toibaro, JavierSkrahin, AliaksandrMiró Meda, José M. (José María), 1956-Caylà i Buqueras, Joan A.Girardi, EnricoBruyand, MathiasObel, NielsPodlekareva, Daria N.Lundgren, Jens D.Mocroft, AmandaKirk, OleAlcaide Fernández de Vega, FernandoTB:HIV study group in EuroCoordTuberculosiVIH (Virus)Infeccions per VIHResistència als medicamentsTerapèuticaEuropa de l'EstEuropa occidentalAmèrica LlatinaTuberculosisHIV (Viruses)HIV infectionsDrug resistanceTherapeuticsEastern EuropeWestern EuropeLatin AmericaObjectives: 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.Public Library of Science (PLoS)2015info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/99640Articles publicats en revistes (Patologia i Terapèutica Experimental)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: http://dx.doi.org/10.1371/journal.pone.0145380PLoS One, 2015, vol. 10, num. 12, p. e0145380http://dx.doi.org/10.1371/journal.pone.0145380info:eu-repo/grantAgreement/EC/FP7/info:eu-repo/grantAgreement/EC/FP7/Vcc-by (c) Efsen, Anne Marie W. et al., 2015http://creativecommons.org/licenses/by/3.0/esinfo:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/996402026-05-27T06:46:51Z
dc.title.none.fl_str_mv Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America
title Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America
spellingShingle Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America
Efsen, Anne Marie W.
Tuberculosi
VIH (Virus)
Infeccions per VIH
Resistència als medicaments
Terapèutica
Europa de l'Est
Europa occidental
Amèrica Llatina
Tuberculosis
HIV (Viruses)
HIV infections
Drug resistance
Therapeutics
Eastern Europe
Western Europe
Latin America
title_short Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America
title_full Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America
title_fullStr Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America
title_full_unstemmed Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America
title_sort Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America
dc.creator.none.fl_str_mv Efsen, Anne Marie W.
Schultze, Anna
Post, Frank A.
Panteleev, Alexander
Furrer, Hansjakob
Miller, Robert F.
Losso, Marcelo H.
Toibaro, Javier
Skrahin, Aliaksandr
Miró Meda, José M. (José María), 1956-
Caylà i Buqueras, Joan A.
Girardi, Enrico
Bruyand, Mathias
Obel, Niels
Podlekareva, Daria N.
Lundgren, Jens D.
Mocroft, Amanda
Kirk, Ole
Alcaide Fernández de Vega, Fernando
TB:HIV study group in EuroCoord
author Efsen, Anne Marie W.
author_facet Efsen, Anne Marie W.
Schultze, Anna
Post, Frank A.
Panteleev, Alexander
Furrer, Hansjakob
Miller, Robert F.
Losso, Marcelo H.
Toibaro, Javier
Skrahin, Aliaksandr
Miró Meda, José M. (José María), 1956-
Caylà i Buqueras, Joan A.
Girardi, Enrico
Bruyand, Mathias
Obel, Niels
Podlekareva, Daria N.
Lundgren, Jens D.
Mocroft, Amanda
Kirk, Ole
Alcaide Fernández de Vega, Fernando
TB:HIV study group in EuroCoord
author_role author
author2 Schultze, Anna
Post, Frank A.
Panteleev, Alexander
Furrer, Hansjakob
Miller, Robert F.
Losso, Marcelo H.
Toibaro, Javier
Skrahin, Aliaksandr
Miró Meda, José M. (José María), 1956-
Caylà i Buqueras, Joan A.
Girardi, Enrico
Bruyand, Mathias
Obel, Niels
Podlekareva, Daria N.
Lundgren, Jens D.
Mocroft, Amanda
Kirk, Ole
Alcaide Fernández de Vega, Fernando
TB:HIV study group in EuroCoord
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Tuberculosi
VIH (Virus)
Infeccions per VIH
Resistència als medicaments
Terapèutica
Europa de l'Est
Europa occidental
Amèrica Llatina
Tuberculosis
HIV (Viruses)
HIV infections
Drug resistance
Therapeutics
Eastern Europe
Western Europe
Latin America
topic Tuberculosi
VIH (Virus)
Infeccions per VIH
Resistència als medicaments
Terapèutica
Europa de l'Est
Europa occidental
Amèrica Llatina
Tuberculosis
HIV (Viruses)
HIV infections
Drug resistance
Therapeutics
Eastern Europe
Western Europe
Latin America
description 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.
publishDate 2015
dc.date.none.fl_str_mv 2015
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/99640
url https://hdl.handle.net/2445/99640
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: http://dx.doi.org/10.1371/journal.pone.0145380
PLoS One, 2015, vol. 10, num. 12, p. e0145380
http://dx.doi.org/10.1371/journal.pone.0145380
info:eu-repo/grantAgreement/EC/FP7/
info:eu-repo/grantAgreement/EC/FP7/V
dc.rights.none.fl_str_mv cc-by (c) Efsen, Anne Marie W. et al., 2015
http://creativecommons.org/licenses/by/3.0/es
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Efsen, Anne Marie W. et al., 2015
http://creativecommons.org/licenses/by/3.0/es
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Public Library of Science (PLoS)
publisher.none.fl_str_mv Public Library of Science (PLoS)
dc.source.none.fl_str_mv Articles publicats en revistes (Patologia i Terapèutica Experimental)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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