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 in | PloS one Vol. 10; no. 12; p. e0145380 |
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Main Authors | , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Public Library of Science
30.12.2015
Public Library of Science (PLoS) |
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Abstract | 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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AbstractList | Objectives 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). Design and Methods 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. Results 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 [greater than or equal to]3 active drugs in 66% of participants in EE compared with 90-96% in other regions (p<0.0001). Conclusions 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. 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. 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. 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 [greater than or equal to]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. Objectives: 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). Design and methods: 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. Results: 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). Conclusions: 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. Objectives 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). Design and Methods 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. Results 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). Conclusions 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. OBJECTIVESRates 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).DESIGN AND METHODSBetween 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.RESULTSSignificant 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).CONCLUSIONSIn 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. |
Audience | Academic |
Author | Miller, Robert F Miro, Jose M Efsen, Anne Marie W Mocroft, Amanda Panteleev, Alexander Furrer, Hansjakob Lundgren, Jens D Caylà, Joan A Post, Frank A Toibaro, Javier Podlekareva, Daria N Girardi, Enrico Schultze, Anna Losso, Marcelo H Obel, Niels Skrahin, Aliaksandr Kirk, Ole Bruyand, Mathias |
AuthorAffiliation | 3 Department of Sexual Health, Caldecot Centre, King's College Hospital, London, United Kingdom 8 Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus 10 Agencia de Salud Pública de Barcelona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB); Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain 12 INSERM, ISPED, Centre Inserm U897- Epidemiologie-Biostatistique, Bordeaux, France 7 Department of immunocompromised, Hospital J.M. Ramos Mejia, Buenos Aires, Argentina 2 Department of Infection and Population Health, University College London Medical School, London, United Kingdom 13 Department of Infectious Diseases and Rheumatology, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark 4 Department of HIV/TB, TB hospital 2, St. Petersburg, Russia 5 Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Swi |
AuthorAffiliation_xml | – name: 4 Department of HIV/TB, TB hospital 2, St. Petersburg, Russia – name: 10 Agencia de Salud Pública de Barcelona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB); Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain – name: 1 Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases and Rheumatology, CHIP, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark – name: 6 Centre for Sexual Health and HIV Research, Mortimer Market Centre, University College London, London, United Kingdom – name: 5 Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland – name: 7 Department of immunocompromised, Hospital J.M. Ramos Mejia, Buenos Aires, Argentina – name: 3 Department of Sexual Health, Caldecot Centre, King's College Hospital, London, United Kingdom – name: 11 Department of Infectious Diseases INMI "L. Spallanzani", Ospedale L Spallanzani, Rome, Italy – name: 9 Infectious Diseases Service, Hospital Clinic–IDIBAPS. University of Barcelona, Barcelona, Spain – name: 12 INSERM, ISPED, Centre Inserm U897- Epidemiologie-Biostatistique, Bordeaux, France – name: 2 Department of Infection and Population Health, University College London Medical School, London, United Kingdom – name: 13 Department of Infectious Diseases and Rheumatology, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark – name: FIOCRUZ, BRAZIL – name: 8 Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus |
Author_xml | – sequence: 1 givenname: Anne Marie W surname: Efsen fullname: Efsen, Anne Marie W organization: Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases and Rheumatology, CHIP, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark – sequence: 2 givenname: Anna surname: Schultze fullname: Schultze, Anna organization: Department of Infection and Population Health, University College London Medical School, London, United Kingdom – sequence: 3 givenname: Frank A surname: Post fullname: Post, Frank A organization: Department of Sexual Health, Caldecot Centre, King's College Hospital, London, United Kingdom – sequence: 4 givenname: Alexander surname: Panteleev fullname: Panteleev, Alexander organization: Department of HIV/TB, TB hospital 2, St. Petersburg, Russia – sequence: 5 givenname: Hansjakob surname: Furrer fullname: Furrer, Hansjakob organization: Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland – sequence: 6 givenname: Robert F surname: Miller fullname: Miller, Robert F organization: Centre for Sexual Health and HIV Research, Mortimer Market Centre, University College London, London, United Kingdom – sequence: 7 givenname: Marcelo H surname: Losso fullname: Losso, Marcelo H organization: Department of immunocompromised, Hospital J.M. Ramos Mejia, Buenos Aires, Argentina – sequence: 8 givenname: Javier surname: Toibaro fullname: Toibaro, Javier organization: Department of immunocompromised, Hospital J.M. Ramos Mejia, Buenos Aires, Argentina – sequence: 9 givenname: Aliaksandr surname: Skrahin fullname: Skrahin, Aliaksandr organization: Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus – sequence: 10 givenname: Jose M surname: Miro fullname: Miro, Jose M organization: Infectious Diseases Service, Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain – sequence: 11 givenname: Joan A surname: Caylà fullname: Caylà, Joan A organization: Agencia de Salud Pública de Barcelona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB); Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain – sequence: 12 givenname: Enrico surname: Girardi fullname: Girardi, Enrico organization: Department of Infectious Diseases INMI "L. Spallanzani", Ospedale L Spallanzani, Rome, Italy – sequence: 13 givenname: Mathias surname: Bruyand fullname: Bruyand, Mathias organization: INSERM, ISPED, Centre Inserm U897- Epidemiologie-Biostatistique, Bordeaux, France – sequence: 14 givenname: Niels surname: Obel fullname: Obel, Niels organization: Department of Infectious Diseases and Rheumatology, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark – sequence: 15 givenname: Daria N surname: Podlekareva fullname: Podlekareva, Daria N organization: Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases and Rheumatology, CHIP, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark – sequence: 16 givenname: Jens D surname: Lundgren fullname: Lundgren, Jens D organization: Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases and Rheumatology, CHIP, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark – sequence: 17 givenname: Amanda surname: Mocroft fullname: Mocroft, Amanda organization: Department of Infection and Population Health, University College London Medical School, London, United Kingdom – sequence: 18 givenname: Ole surname: Kirk fullname: Kirk, Ole organization: Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases and Rheumatology, CHIP, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26716686$$D View this record in MEDLINE/PubMed |
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ContentType | Journal Article |
Contributor | Universitat de Barcelona |
Contributor_xml | – sequence: 1 fullname: Universitat de Barcelona |
Copyright | COPYRIGHT 2015 Public Library of Science 2015 Efsen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. cc-by (c) Efsen, Anne Marie W. et al., 2015 info:eu-repo/semantics/openAccess http://creativecommons.org/licenses/by/3.0/es 2015 Efsen et al 2015 Efsen et al |
Copyright_xml | – notice: COPYRIGHT 2015 Public Library of Science – notice: 2015 Efsen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: cc-by (c) Efsen, Anne Marie W. et al., 2015 info:eu-repo/semantics/openAccess <a href="http://creativecommons.org/licenses/by/3.0/es">http://creativecommons.org/licenses/by/3.0/es</a> – notice: 2015 Efsen et al 2015 Efsen et al |
CorporateAuthor | TB:HIV study group in EuroCoord |
CorporateAuthor_xml | – sequence: 0 name: TB:HIV study group in EuroCoord – name: TB:HIV study group in EuroCoord |
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DOI | 10.1371/journal.pone.0145380 |
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Notes | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 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. |
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Snippet | Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics, factors... Objectives Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics,... OBJECTIVESRates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics,... Objectives: rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics,... Objectives Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics,... |
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SubjectTerms | 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 |
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Title | Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America |
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