CHIP, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark.
Department of Infection and Population Health, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK.
J Infect. 2018 Jan;76(1):44-54. doi: 10.1016/j.jinf.2017.10.007. Epub 2017 Oct 20.
Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce.
In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART).
A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5-74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%.
Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care.
在东欧（EE），HIV 合并结核病（TB）患者的死亡率仍然很高，但 TB 和 HIV 管理的细节仍然很少。
在这项前瞻性研究中，我们描述了耐多药（MDR）TB 患者的 TB 治疗方案和抗逆转录病毒治疗（ART）的使用情况。
共有 105 例 HIV 阳性患者患有 MDR-TB（包括 33 例广泛耐药）和 130 例全敏感 TB。与全敏感 TB 患者的 80%相比，仅有 8%的 MDR-TB 患者接受了适当的初始 TB 治疗。到 12 个月时，估计有 57.3%（95%CI 41.5-74.1）的 MDR-TB 患者开始接受适当的治疗。尽管有 67%的患者接受了 ART，但只有 23%的患者 HIV-RNA 得到了抑制。
我们的结果表明，国际推荐的 MDR-TB 治疗方案很少使用，ART 的使用和病毒抑制率远低于 90%的目标，这反映了患者人群的挑战性和提供医疗保健的环境。迫切需要改善 EE 地区的 TB/HIV 患者管理，特别是对 MDR-TB 患者，包括广泛获得快速 TB 诊断、更好地获得和使用二线 TB 药物、及时开始 ART 并进行病毒载量监测，以及整合 TB/HIV 护理。
