title: Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia.
abstract: METHODS
  A referral hospital for tuberculosis (TB) in Irkutsk, the Russian Federation.
  
  
  OBJECTIVE
  To describe disease characteristics, treatment and hospital outcomes of TB-HIV (human immunodeficiency virus).
  
  
  METHODS
  Observational cohort of HIV-infected patients admitted for anti-tuberculosis treatment over 6 months.
  
  
  RESULTS
  A total of 98 patients were enrolled with a median CD4 count of 147 cells/mm(3) and viral load of 205 943 copies/ml. Among patients with drug susceptibility testing (DST) results, 29 (64%) were multidrug-resistant (MDR), including 12 without previous anti-tuberculosis treatment. Nineteen patients were on antiretroviral therapy (ART) at admission, and 10 (13% ART-naïve) were started during hospitalization. Barriers to timely ART initiation included death, in-patient treatment interruption, and patient refusal. Of 96 evaluable patients, 21 (22%) died, 14 (15%) interrupted treatment, and 10 (10%) showed no microbiological or radiographic improvement. Patients with a cavitary chest X-ray (aOR 7.4, 95%CI 2.3-23.7, P = 0.001) or central nervous system disease (aOR 6.5, 95%CI 1.2-36.1, P = 0.03) were more likely to have one of these poor outcomes.
  
  
  CONCLUSIONS
  High rates of MDR-TB, treatment interruption and death were found in an HIV-infected population hospitalized in Irkutsk. There are opportunities for integration of HIV and TB services to overcome barriers to timely ART initiation, increase the use of anti-tuberculosis regimens informed by second-line DST, and strengthen out-patient diagnosis and treatment networks.
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Heysell
authors.affiliation: Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation; Regional TB Prevention Dispensary, Irkutsk, Russian Federation.
authors.forename: O B
authors.initials: OB
authors.lastname: Ogarkov
authors.affiliation: Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation.
authors.forename: S
authors.initials: S
authors.lastname: Zhdanova
authors.affiliation: Regional TB Prevention Dispensary, Irkutsk, Russian Federation; State Medical Continuing Education Academy, Irkutsk, Russian Federation.
authors.forename: E
authors.initials: E
authors.lastname: Zorkaltseva
authors.affiliation: Regional TB Prevention Dispensary, Irkutsk, Russian Federation.
authors.forename: S
authors.initials: S
authors.lastname: Shugaeva
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: J
authors.initials: J
authors.lastname: Gratz
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: S
authors.initials: S
authors.lastname: Vitko
authors.affiliation: Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation; State Medical Continuing Education Academy, Irkutsk, Russian Federation.
authors.forename: E D
authors.initials: ED
authors.lastname: Savilov
authors.affiliation: Regional TB Prevention Dispensary, Irkutsk, Russian Federation.
authors.forename: M E
authors.initials: ME
authors.lastname: Koshcheyev
authors.affiliation: <sup>*</sup>Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: E R
authors.initials: ER
authors.lastname: Houpt
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D060085:Coinfection; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D015999:Multivariate Analysis; D016017:Odds Ratio; D012017:Referral and Consultation; D012307:Risk Factors; D012800:Siberia / Q000453:epidemiology; D016896:Treatment Outcome; D016312:Treatment Refusal; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents