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Free Content Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia

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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/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.
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Keywords: Russian Federation; extensively drug-resistant TB; human immunodeficiency virus; injection drug use; multidrug-resistant TB

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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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

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    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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