Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia
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/mm3 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.
Document Type: Research Article
Affiliations: 1: *Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA 2: †Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, †Regional TB Prevention Dispensary, Irkutsk 3: †Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk 4: †Regional TB Prevention Dispensary, Irkutsk, §State Medical Continuing Education Academy, Irkutsk, Russian Federation 5: †Regional TB Prevention Dispensary, Irkutsk 6: †Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, §State Medical Continuing Education Academy, Irkutsk, Russian Federation
Publication date: February 1, 2016
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