Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America

Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western...

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Published inPloS one Vol. 10; no. 12; p. e0145380
Main Authors Efsen, Anne Marie W, Schultze, Anna, Post, Frank A, Panteleev, Alexander, Furrer, Hansjakob, Miller, Robert F, Losso, Marcelo H, Toibaro, Javier, Skrahin, Aliaksandr, Miro, Jose M, Caylà, Joan A, Girardi, Enrico, Bruyand, Mathias, Obel, Niels, Podlekareva, Daria N, Lundgren, Jens D, Mocroft, Amanda, Kirk, Ole
Format Journal Article
LanguageEnglish
Published United States Public Library of Science 30.12.2015
Public Library of Science (PLoS)
Subjects
Adult
Amèrica Llatina
Analysis
Anti-Retroviral Agents - therapeutic use
Antiretroviral agents
Antiretroviral therapy
Antitubercular Agents - therapeutic use
Care and treatment
Coinfection - drug therapy
Collaboration
Comorbidity
Diagnosis
Drug resistance
Drug therapy
Drugs
Eastern Europe
Europa de l'Est
Europa Occidental
Europe
Europe, Eastern
Female
Hepatitis
Highly active antiretroviral therapy
HIV
HIV (Viruses)
HIV infections
HIV Infections - drug therapy
Hospitals
Human immunodeficiency virus
Humans
Infeccions per VIH
Infections
Infectious diseases
Latin America
Male
Medical diagnosis
Middle Aged
Mortality
Multidrug resistance
Multidrug resistant organisms
Narcotics
Patients
Prospective Studies
Resistència als medicaments
Rheumatology
Risk Factors
Studies
Substance abuse treatment
Systematic review
Terapèutica
Therapeutics
Therapy
Tuberculosi
Tuberculosis
Tuberculosis, Multidrug-Resistant - drug therapy
VIH (Virus)
Western Europe
Europe, Eastern
Europe
Latin America
Eastern Europe
Western Europe
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Summary:Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA). Between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled. Significant differences were observed between EE (N = 844), WE (N = 152), SE (N = 164), and LA (N = 253) in the proportion of patients with a definite TB diagnosis (47%, 71%, 72% and 40%, p<0.0001), MDR-TB (40%, 5%, 3% and 15%, p<0.0001), and use of combination antiretroviral therapy (cART) (17%, 40%, 44% and 35%, p<0.0001). Injecting drug use (adjusted OR (aOR) = 2.03 (95% CI 1.00-4.09), prior anti-TB treatment (3.42 (1.88-6.22)), and living in EE (7.19 (3.28-15.78)) were associated with MDR-TB. Among 585 patients with drug susceptibility test (DST) results, the empiric (i.e. without knowledge of the DST results) anti-TB treatment included ≥3 active drugs in 66% of participants in EE compared with 90-96% in other regions (p<0.0001). In EE, TB/HIV patients were less likely to receive a definite TB diagnosis, more likely to house MDR-TB and commonly received empiric anti-TB treatment with reduced activity. Improved management of TB/HIV patients in EE requires better access to TB diagnostics including DSTs, empiric anti-TB therapy directed at both susceptible and MDR-TB, and more widespread use of cART.
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Conceived and designed the experiments: AWE ASC AM DNP JDL OK. Performed the experiments: AWE ASC AM DNP JDL OK. Analyzed the data: AWE ASC AM DNP JDL OK FP AP HF RM MHL JT ASK JMM JAC EG MB NO. Contributed reagents/materials/analysis tools: AWE ASC AM DNP JDL OK FP AP HF RM MHL JT ASK JMM JAC EG MB NO. Wrote the paper: AWE ASC AM DNP JDL OK FP AP HF RM MHL JT ASK JMM JAC EG MB NO. Performed statistical analyses: ASC AM.
Competing Interests: AMW reports a personal grant from University Hospital Copenhagen. AS reports grants and travel support from University College London. HF reports consultancy fees from ViiV, Gilead, Abbvie, MSD, Jannsen, BMS and grants from ViiV, Gilead, AbbVie, Roche, Boehringer, MSD, BMS, Janssen outside the submitted work. RM reports payment for lectures from ViiV, Merck, Gilead and Janssen outside the submitted work. JMM reports consultancy fees from Abbvie, Novartis, payment for lectures from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Merck and Novartis y ViiV Healthcare and grants from Cubist, Gilead, ViiV Healthcare, Novartis, Merck, Fondo de Investigaciones Sanitarias - Instituto de Salud Carlos III, Fundación para la Investigación y Prevención del Sida en España, Ministerio de Sanidad, Servicios Sociales e Igualdad, National Institutes of Health and NEAT outside the submitted work. EG reports board membership for Janssen-Cilag, consultancy fees from Abbot-Diagnostics, payment for lectures from BMS, ViiV Healthcare, Jannsen and grants from Gilead Sciences outside the submitted work. JT reports grants from EuroCoord and University of Buenos Aires, CICAL during conduct of the study. MHL reports grants from EuroCoord, employment from University of Buenos Aires, Hospital JM Ramos Mejia, CICAL and grants from NIH, University of Minnesota, University of New South Wales, travel fees from Gador outside the submitted work. AM reports speaker fees, travel fees and honorarium from BI, Gilead, Pfizer, Merck and BMS outside the submitted work. OK reports board membership from Gilead, Merck, ViiV, consultancy fees from Gilead, payment for lectures from Abbott, Gilead, Tibotec, travel fees from Abbott, BMS, Gilead, Merck, ViiV and grants from Bristol-Myers Squibb, Janssen, Merck, Pfizer, GlaxoSmithKline outside the submitted work. For the remaining authors, none were declared. Although several authors have received grants, honoraria or travel support from a number of pharmaceutical companies, none have declared a conflict of interest in relation to the work presented in this manuscript. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
Membership of the TB:HIV Study Group investigators is provided in the Acknowledgements.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0145380