Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study. Â Â Journal of Infection
Efsen et al. on behalf of the TB: HIV study in EuroCoord aimed to describe the tuberculosis (TB) treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART) in Eastern Europe. MDR-TB was defined as TB resistant to rifampicin and isoniazid, whereas extensively drug-resistant tuberculosis (XDR-TB) had additional resistance against a fluoroquinolone and a second-line injectable drug.
Overall, 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%.
In conclusion, the study shows that in Eastern Europe there is an urgent need for access to rapid diagnostics to guide initial TB treatment, to extend susceptibility testing to all patients diagnosed with rifamycin-resistant or MDR-TB and to provide better access to second line drugs to allow the administration of optimally active MDR-TB regimens. Integration of TB and HIV services can ensure better management and support for people with HIV who frequently have IDU and hepatitis C virus coinfection, including rapid initiation of fully suppressive ART.