Drug-resistant tuberculosis and HIV in Ukraine: a threatening convergence of two epidemics?
OBJECTIVE
To investigate anti-tuberculosis (TB) drug resistance rates in Donetsk Oblast, Ukraine, and to explore the association between the epidemics of human immunodeficiency virus (HIV) and multidrug-resistant TB (MDR-TB).


METHODS
All consecutive newly diagnosed and previously treated patients with sputum smear-positive TB presenting to all TB units in Donetsk Oblast over 12 months were invited to take part in the study. A total of 1293 and 203 patients with TB were tested for HIV and MDR-TB in the civilian and penitentiary sectors, respectively.


RESULTS
Of those enrolled for the study, 307 were HIV-positive, 379 had MDR-TB, and 97 had MDR-TB and HIV co-infection. MDR-TB rates in the civilian sector were respectively 15.5% (95%CI 13.1-17.8) and 41.5% (95%CI 36.4-46.5) in newly diagnosed and previously treated TB patients. Among prisoners, MDR-TB rates were 21.8% (95%CI 12.4-31.2) in new cases and 52.8% (95%CI 43.9-61.7) in previously treated TB cases. HIV status was significantly associated with MDR-TB (OR 1.7, 95%CI 1.3-2.3).


CONCLUSIONS
High MDR-TB rates and a positive association between MDR-TB and HIV epidemics were found in Donetsk Oblast. Urgent measures to improve HIV prevention, control of drug-resistant TB and collaboration between HIV and TB control activities need to be implemented without further delay.
Dubrovina
I
I
Project Office, World Health Organization, Donetsk, Ukraine.
Miskinis
K
K
Lyepshina
S
S
Yann
Y
Y
Hoffmann
H
H
Zaleskis
R
R
Nunn
P
P
Zignol
M
M
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011329:Prisoners; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*; D014455:Ukraine / Q000453:epidemiology
D000995:Antitubercular Agents