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

Abstract

SUMMARY 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.

Individualizing management of extensively drug-resistant tuberculosis: diagnostics, treatment, and biomarkers

“…In South Africa where HIV diagnostic testing and capacity for drug-susceptibility testing of MTB isolates is robust, 40-80% of patients with XDR-TB are HIV infected [23,24]. In the Russian Federation and Eastern Europe, XDR-TB and HIV are often associated with injection drug use [25]. In a Latvian cohort of 5,200 TB patients, the risk of developing drug-resistant TB was double in HIV infection compared to those without HIV [26].…”

Pharmacokinetics of tuberculosis drugs in HIV-infected patients from Irkutsk, Russian Federation: redefining drug activity

“…Management of the drug-resistant TB epidemic in the Siberian province of Irkutsk is further complicated by high rates of HIV co-infection [2], which leads to early mortality and risk for acquired Mycobacterium tuberculosis drug resistance [3]. Such poor treatment outcomes may be in part a consequence of pharmacokinetic variability rendering subtherapeutic drug concentrations [4–6].…”

Reproductive Disorders and Their Pathogenetic Mechanisms in Women With Hiv

“…Часто ВИЧ-инфицированные женщины сообщают о нарушениях менструального цикла [7]. Нарушения менструальной функции могут быть обусловлены целым рядом причин, которые непосредственно не связаны с болезнью: влиянием приема наркотических препаратов, социально-экономическими факторами, сопутствующими заболеваниями, психическими проблемами и использованием психотропных препаратов [8]. ВИЧ-серопозитивные женщины подвергаются влиянию множественных стрессовых факторов, что может вызывать вторичную аменорею, ациклические маточные кровотечения; прием антиретровирусных препаратов, таких как индинавир, может приводить к меноррагии или метроррагии [7][8][9].…”