title: Multi-drug-resistant tuberculosis in HIV positive patients in Eastern Europe.
abstract: Observational data from Eastern Europe on the management and outcome of multi-drug-resistant tuberculosis (MDR TB) in HIV positive populations remain sparse in the English-language literature. We compared clinical characteristics and outcomes of 55 patients who were diagnosed with HIV and MDR TB in Eastern Europe between 2004 and 2006 to 89 patients whose Mycobacterium tuberculosis isolates were susceptible to isoniazid and rifampicin. Patients with HIV and MDR TB were young and predominantly male with high rates of intravenous drug use, imprisonment and hepatitis C co-infection. Eighty-four per cent of patients with MDR TB had no history of previous TB drug exposure suggesting that the majority of MDR TB resulted from transmission of drug-resistant M. tuberculosis. The use of non-standardized tuberculosis treatment was common, and the use of antiretroviral therapy infrequent. Compared to those with susceptible tuberculosis, patients with MDR TB were less likely to achieve cure or complete tuberculosis treatment (21.8% vs. 62.9%, p < 0.0001), and they were more likely to die (65.5% vs. 27.0%, p < 0.0001). Our study documents suboptimal management and poor outcomes in HIV positive patients with MDR TB. Implementation of WHO guidelines, rapid TB diagnostics and TB drug susceptibility testing for all patients remain a priority in this region.
authors.affiliation: King's College London School of Medicine, London SE5 9RJ, UK. Electronic address: frank.post@kcl.ac.uk.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Post
authors.affiliation: University College London, London, London NW3 2PF, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grint
authors.affiliation: Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Werlinrud
authors.affiliation: TB Hospital #2, St. Petersburg, Russia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Panteleev
authors.affiliation: State Agency of TB and Lung Diseases, Riga, Latvia.
authors.forename: Vieja
authors.initials: V
authors.lastname: Riekstina
authors.affiliation: Botkin Hospital of Infectious Diseases, St. Petersburg, Russia.
authors.forename: Evgeniy A
authors.initials: EA
authors.lastname: Malashenkov
authors.affiliation: Research Institute of Pulmonology and Pulmonary Tuberculosis, Minsk, Belarus.
authors.forename: Alena
authors.initials: A
authors.lastname: Skrahina
authors.affiliation: Spitalul de Boli Infectioase si Tropicale, Bucharest, Romania.
authors.forename: Dan
authors.initials: D
authors.lastname: Duiculescu
authors.affiliation: Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Daria
authors.initials: D
authors.lastname: Podlekareva
authors.affiliation: Minsk State Medical University, Department of Infectious Diseases, Minsk, Belarus.
authors.forename: Igor
authors.initials: I
authors.lastname: Karpov
authors.affiliation: Gomel Regional TB Hospital, Gomel, Belarus.
authors.forename: Vasiliy
authors.initials: V
authors.lastname: Bondarenko
authors.affiliation: Kiev City AIDS Centre, Kiev, Ukraine.
authors.forename: Nelly
authors.initials: N
authors.lastname: Chentsova
authors.affiliation: Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Lundgren
authors.affiliation: University College London, London, London NW3 2PF, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.affiliation: Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.affiliation: Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality
chemical_list: D000995:Antitubercular Agents
keywords: Eastern Europe; HIV; MDR; Resistant; Tuberculosis