Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia.
Int J Tuberc Lung Dis
; 20(2): 187-92, 2016 Feb.
Article
in En
| MEDLINE
| ID: mdl-26792470
ABSTRACT
SETTING:
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).DESIGN:
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.CONCLUSION:
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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Referral and Consultation
/
HIV Infections
/
Tuberculosis, Multidrug-Resistant
/
Drug Resistance, Multiple, Bacterial
/
Coinfection
/
Hospitalization
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Male
Country/Region as subject:
Asia
Language:
En
Journal:
Int J Tuberc Lung Dis
Year:
2016
Document type:
Article
Affiliation country:
Estados Unidos