Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia
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 treatmen...
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| Veröffentlicht in: | The international journal of tuberculosis and lung disease 2016-02, Vol.20 (2), p.187-192 |
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| creator | Heysell, S. K. Ogarkov, O. B. Zhdanova, S. Zorkaltseva, E. Shugaeva, S. Gratz, J. Vitko, S. Savilov, E. D. Koshcheyev, M. E. Houpt, E. R. |
| description | 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. |
| doi_str_mv | 10.5588/ijtld.14.0961 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1808722200</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ingid>iuatld/ijtld/2016/00000020/00000002/art00011</ingid><sourcerecordid>1808722200</sourcerecordid><originalsourceid>FETCH-LOGICAL-c555t-1c83e7b657030bc7eeee4ec6ae39fce8a7e289f17058e53d22ce353a8bd3549c3</originalsourceid><addsrcrecordid>eNqFkU1v1DAQhiMEoqVw5Ip85ECWsR3HzgUJlY-uVAkhKBcOI8eZ3XqbTba2Uwl-Pd7NUsEBMZcZ2Y_e-XiL4jmHhVLGvPab1HcLXi2gqfmD4pQbrkrdCHiYaxC6lJo3J8WTGDcAgnOuHxcnos5EpeG0-H41dBRSIJuoYxfLb8wOHevCtC4DRR-THRJLU0vBTf2YH5hNzLJAKwrB9ux6jDufcuEHtgw3U4o3r9gXn3lvnxaPVraP9OyYz4qrD--_nl-Ul58-Ls_fXpZOKZVK7owk3dZKg4TWacpRkastyWblyFhNwjQrrkEZUrITwpFU0pq2k6pqnDwr3sy6u6ndUudoSHk03AW_teEHjtbj3z-Dv8b1eIeVqWVT6Szw8igQxtuJYsKtj4763g40ThG5AaOFEAD_R3UN-fjKVBktZ9SFMcZ8sfuJOODeOzx4h7zCvXeZf_HnGvf0b7My8HkG_LDOm1jcjFMY8mXRO_STPYhly_eO452AQaDIloMRCrkCiR2t7NQnTDbg-idGvm_67l-as-A8owBeIxxCwLEAgTaknLPMLxrYyLI</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1760920584</pqid></control><display><type>article</type><title>Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia</title><source>MEDLINE</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Heysell, S. K. ; Ogarkov, O. B. ; Zhdanova, S. ; Zorkaltseva, E. ; Shugaeva, S. ; Gratz, J. ; Vitko, S. ; Savilov, E. D. ; Koshcheyev, M. E. ; Houpt, E. R.</creator><creatorcontrib>Heysell, S. K. ; Ogarkov, O. B. ; Zhdanova, S. ; Zorkaltseva, E. ; Shugaeva, S. ; Gratz, J. ; Vitko, S. ; Savilov, E. D. ; Koshcheyev, M. E. ; Houpt, E. R.</creatorcontrib><description>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.</description><identifier>ISSN: 1027-3719</identifier><identifier>EISSN: 1815-7920</identifier><identifier>DOI: 10.5588/ijtld.14.0961</identifier><identifier>PMID: 26792470</identifier><language>eng</language><publisher>France: International Union Against Tuberculosis and Lung Disease</publisher><subject>Adult ; Anti-HIV Agents - therapeutic use ; Antitubercular Agents - therapeutic use ; Chi-Square Distribution ; Coinfection ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Extensively Drug-Resistant Tb ; Female ; HIV Infections - diagnosis ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV Infections - mortality ; Hospital Mortality ; Hospitalization ; Human Immunodeficiency Virus ; Humans ; Injection Drug Use ; Lentivirus ; Logistic Models ; Male ; Microbial Sensitivity Tests ; Multidrug-Resistant Tb ; Multivariate Analysis ; Mycobacterium ; Odds Ratio ; Referral and Consultation ; Risk Factors ; Russian Federation ; Siberia - epidemiology ; Treatment Outcome ; Treatment Refusal ; Tuberculosis, Multidrug-Resistant - diagnosis ; Tuberculosis, Multidrug-Resistant - drug therapy ; Tuberculosis, Multidrug-Resistant - epidemiology ; Tuberculosis, Multidrug-Resistant - mortality</subject><ispartof>The international journal of tuberculosis and lung disease, 2016-02, Vol.20 (2), p.187-192</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c555t-1c83e7b657030bc7eeee4ec6ae39fce8a7e289f17058e53d22ce353a8bd3549c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863947/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863947/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26792470$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Heysell, S. K.</creatorcontrib><creatorcontrib>Ogarkov, O. B.</creatorcontrib><creatorcontrib>Zhdanova, S.</creatorcontrib><creatorcontrib>Zorkaltseva, E.</creatorcontrib><creatorcontrib>Shugaeva, S.</creatorcontrib><creatorcontrib>Gratz, J.</creatorcontrib><creatorcontrib>Vitko, S.</creatorcontrib><creatorcontrib>Savilov, E. D.</creatorcontrib><creatorcontrib>Koshcheyev, M. E.</creatorcontrib><creatorcontrib>Houpt, E. R.</creatorcontrib><title>Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia</title><title>The international journal of tuberculosis and lung disease</title><addtitle>Int J Tuberc Lung Dis</addtitle><description>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.</description><subject>Adult</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>Chi-Square Distribution</subject><subject>Coinfection</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Drug Therapy, Combination</subject><subject>Extensively Drug-Resistant Tb</subject><subject>Female</subject><subject>HIV Infections - diagnosis</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - mortality</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Human Immunodeficiency Virus</subject><subject>Humans</subject><subject>Injection Drug Use</subject><subject>Lentivirus</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Microbial Sensitivity Tests</subject><subject>Multidrug-Resistant Tb</subject><subject>Multivariate Analysis</subject><subject>Mycobacterium</subject><subject>Odds Ratio</subject><subject>Referral and Consultation</subject><subject>Risk Factors</subject><subject>Russian Federation</subject><subject>Siberia - epidemiology</subject><subject>Treatment Outcome</subject><subject>Treatment Refusal</subject><subject>Tuberculosis, Multidrug-Resistant - diagnosis</subject><subject>Tuberculosis, Multidrug-Resistant - drug therapy</subject><subject>Tuberculosis, Multidrug-Resistant - epidemiology</subject><subject>Tuberculosis, Multidrug-Resistant - mortality</subject><issn>1027-3719</issn><issn>1815-7920</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhiMEoqVw5Ip85ECWsR3HzgUJlY-uVAkhKBcOI8eZ3XqbTba2Uwl-Pd7NUsEBMZcZ2Y_e-XiL4jmHhVLGvPab1HcLXi2gqfmD4pQbrkrdCHiYaxC6lJo3J8WTGDcAgnOuHxcnos5EpeG0-H41dBRSIJuoYxfLb8wOHevCtC4DRR-THRJLU0vBTf2YH5hNzLJAKwrB9ux6jDufcuEHtgw3U4o3r9gXn3lvnxaPVraP9OyYz4qrD--_nl-Ul58-Ls_fXpZOKZVK7owk3dZKg4TWacpRkastyWblyFhNwjQrrkEZUrITwpFU0pq2k6pqnDwr3sy6u6ndUudoSHk03AW_teEHjtbj3z-Dv8b1eIeVqWVT6Szw8igQxtuJYsKtj4763g40ThG5AaOFEAD_R3UN-fjKVBktZ9SFMcZ8sfuJOODeOzx4h7zCvXeZf_HnGvf0b7My8HkG_LDOm1jcjFMY8mXRO_STPYhly_eO452AQaDIloMRCrkCiR2t7NQnTDbg-idGvm_67l-as-A8owBeIxxCwLEAgTaknLPMLxrYyLI</recordid><startdate>20160201</startdate><enddate>20160201</enddate><creator>Heysell, S. K.</creator><creator>Ogarkov, O. B.</creator><creator>Zhdanova, S.</creator><creator>Zorkaltseva, E.</creator><creator>Shugaeva, S.</creator><creator>Gratz, J.</creator><creator>Vitko, S.</creator><creator>Savilov, E. D.</creator><creator>Koshcheyev, M. E.</creator><creator>Houpt, E. R.</creator><general>International Union Against Tuberculosis and Lung Disease</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QL</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>5PM</scope></search><sort><creationdate>20160201</creationdate><title>Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia</title><author>Heysell, S. K. ; Ogarkov, O. B. ; Zhdanova, S. ; Zorkaltseva, E. ; Shugaeva, S. ; Gratz, J. ; Vitko, S. ; Savilov, E. D. ; Koshcheyev, M. E. ; Houpt, E. 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K.</creatorcontrib><creatorcontrib>Ogarkov, O. B.</creatorcontrib><creatorcontrib>Zhdanova, S.</creatorcontrib><creatorcontrib>Zorkaltseva, E.</creatorcontrib><creatorcontrib>Shugaeva, S.</creatorcontrib><creatorcontrib>Gratz, J.</creatorcontrib><creatorcontrib>Vitko, S.</creatorcontrib><creatorcontrib>Savilov, E. D.</creatorcontrib><creatorcontrib>Koshcheyev, M. E.</creatorcontrib><creatorcontrib>Houpt, E. R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The international journal of tuberculosis and lung disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heysell, S. K.</au><au>Ogarkov, O. B.</au><au>Zhdanova, S.</au><au>Zorkaltseva, E.</au><au>Shugaeva, S.</au><au>Gratz, J.</au><au>Vitko, S.</au><au>Savilov, E. D.</au><au>Koshcheyev, M. E.</au><au>Houpt, E. R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia</atitle><jtitle>The international journal of tuberculosis and lung disease</jtitle><addtitle>Int J Tuberc Lung Dis</addtitle><date>2016-02-01</date><risdate>2016</risdate><volume>20</volume><issue>2</issue><spage>187</spage><epage>192</epage><pages>187-192</pages><issn>1027-3719</issn><eissn>1815-7920</eissn><abstract>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.</abstract><cop>France</cop><pub>International Union Against Tuberculosis and Lung Disease</pub><pmid>26792470</pmid><doi>10.5588/ijtld.14.0961</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Anti-HIV Agents - therapeutic use Antitubercular Agents - therapeutic use Chi-Square Distribution Coinfection Drug Resistance, Multiple, Bacterial Drug Therapy, Combination Extensively Drug-Resistant Tb Female HIV Infections - diagnosis HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - mortality Hospital Mortality Hospitalization Human Immunodeficiency Virus Humans Injection Drug Use Lentivirus Logistic Models Male Microbial Sensitivity Tests Multidrug-Resistant Tb Multivariate Analysis Mycobacterium Odds Ratio Referral and Consultation Risk Factors Russian Federation Siberia - epidemiology Treatment Outcome Treatment Refusal Tuberculosis, Multidrug-Resistant - diagnosis Tuberculosis, Multidrug-Resistant - drug therapy Tuberculosis, Multidrug-Resistant - epidemiology Tuberculosis, Multidrug-Resistant - mortality |
| title | Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia |
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