Undertreated HIV and Drug-Resistant Tuberculosis at a Referral Hospital in Irkutsk, Siberia
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.
- 1Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
- 2Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation; Regional TB Prevention Dispensary, Irkutsk, Russian Federation.
- 3Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation.
- 4Regional TB Prevention Dispensary, Irkutsk, Russian Federation; State Medical Continuing Education Academy, Irkutsk, Russian Federation.
- 5Regional TB Prevention Dispensary, Irkutsk, Russian Federation.
- 6Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation; State Medical Continuing Education Academy, Irkutsk, Russian Federation.
- 7Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
- Int J Tuberc Lung Dis. 2016 Feb;20(2):187-92. doi: 10.5588/ijtld.14.0961.
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