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1. Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality—a multicentre prospective cohort study

Author

Kraef, C, Bentzon, A, Panteleev, A, Skrahina, A, Bolokadze, N, Tetradov, S, Podlasin, R, Karpov, I, Borodulina, E, Denisova, E, Azina, I, Lundgren, J, Johansen, I, Mocroft, A, Podlekareva, D, Kirk, O, Vassilenko, A, Klimuk, D, Kondratenko, O, Zalutskaya, A, Bondarenko, V, Mitsura, V, Kozorez, E, Tumash, O, Suetnov, O, Paduto, D, Iljina, V, Kummik, T, Mshvidobadze, K, Lanchava, N, Goginashvili, L, Mikiashvili, L, Bablishvili, N, Rozentale, B, Zeltina, I, Janushkevich, I, Caplinskiene, I, Caplinskas, S, Kancauskiene, Z, Wiercinska-Drapalo, A, Thompson, M, Kozlowska, J, Grezesczuk, A, Bura, M, Knysz, B, Inglot, M, Garlicki, A, Loster, J, Uiculescu, D, Rakhmanova, A, Panteleev, O, Yakovlev, A, Kozlov, A, Tyukalova, A, Vlasova, Y, Rofimov, T, Kyselyova, G, Obel, N, Gerstoft, J, Kronborg, G, Payen, M, Abeya, K, Necsoi, C, Dabis, F, Tsaranazy, A, Cazanave, C, Furrer, H, Sagette, M, Rickenbach, M, Sculier, D, Calmy, A, Cavassini, M, Bruno, A, Bernasconi, E, Hoffmann, M, Vernazza, P, Fehr, J, Weber, R, Miller, R, Vora, N, Cooke, G, Mullaney, S, Wilkins, E, George, V, Collini, P, Dockrell, D, Post, F, Campbell, L, Brum, R, Mabonga, E, Saigal, P, Kegg, S, Ainsworth, J, Waters, A, Dhar, J, Ellis, K, Girardi, E, Rianda, A, Galati, V, Pinnetti, C, Tommasi, C, Lapadula, G, Di Biagio, A, Parisini, A, Carbonara, S, Angarano, G, Purgatorio, M, Matteelli, A, Apostoli, A, Miro, J, Manzardo, C, Ligero, C, Gonzalez, J, Martinez-Martinez, J, Sanchez, F, Knobel, H, Salvado, M, Lopez-Colomes, J, Martinez-Lacasa, X, Cuchi, E, Falco, V, Curran, A, Tortola, M, Ocana, I, Vidal, R, Sambeat, M, Pomar, V, Coll, P, Pozamczer, D, Saumoy, M, Alcaide, F, Cayla, J, Moreno, A, Millet, J, Orcau, A, Fina, L, Romero, A, Roldan, L, Iribarren, J, Ibarguren, M, Moreno, S, Gonzalez, A, Miralles, P, Aldamiz-Echevarria, T, Losso, M, Toibaro, J, Gambardella, L, Moreno Macias, L, Warley, E, Tavella, S, Garcia Messina, O, Gear, O, Laplume, H, Marson, C, Contarelia, J, Michaan, M, Scapellato, P, Bartoletti, B, Palmero, D, Elias, C, Cortes, C, Crabtree, B, Mosqueda Gomez, J, Villanueva, J, Gonzalez Hernandez, L, Badial, F, Kraef C., Bentzon A., Panteleev A., Skrahina A., Bolokadze N., Tetradov S., Podlasin R., Karpov I., Borodulina E., Denisova E., Azina I., Lundgren J., Johansen I. S., Mocroft A., Podlekareva D., Kirk O., Vassilenko A., Klimuk D., Kondratenko O., Zalutskaya A., Bondarenko V., Mitsura V., Kozorez E., Tumash O., Suetnov O., Paduto D., Iljina V., Kummik T., Mshvidobadze K., Lanchava N., Goginashvili L., Mikiashvili L., Bablishvili N., Rozentale B., Zeltina I., Janushkevich I., Caplinskiene I., Caplinskas S., Kancauskiene Z., Wiercinska-Drapalo A., Thompson M., Kozlowska J., Grezesczuk A., Bura M., Knysz B., Inglot M., Garlicki A., Loster J., uiculescu D. D., Rakhmanova A., Panteleev O., Yakovlev A., Kozlov A., Tyukalova A., Vlasova Y., rofimov T. T., Kyselyova G., Obel N., Gerstoft J., Kronborg G., Payen M. C., abeya K. K., Necsoi C., Dabis F., Tsaranazy A., Cazanave C., Furrer H., Sagette M., Rickenbach M., Sculier D., Calmy A., Cavassini M., Bruno A., Bernasconi E., Hoffmann M., Vernazza P., Fehr J., Weber R., Miller R., Vora N., Cooke G., Mullaney S., Wilkins E., George V., Collini P., Dockrell D., Post F., Campbell L., Brum R., Mabonga E., Saigal P., Kegg S., Ainsworth J., Waters A., Dhar J., Ellis K., Girardi E., Rianda A., Galati V., Pinnetti C., Tommasi C., Lapadula G., Di Biagio A., Parisini A., Carbonara S., Angarano G., Purgatorio M., Matteelli A., Apostoli A., Miro J. M., Manzardo C., Ligero C., Gonzalez J., Martinez-Martinez J. A., Sanchez F., Knobel H., Salvado M., Lopez-Colomes J. L., Martinez-Lacasa X., Cuchi E., Falco V., Curran A., Tortola M. T., Ocana I., Vidal R., Sambeat M. A., Pomar V., Coll P., Pozamczer D., Saumoy M., Alcaide F., Cayla J., Moreno A., Millet J. P., Orcau A., Fina L., Romero A., Roldan L. L., Iribarren J. A., Ibarguren M., Moreno S., Gonzalez A., Miralles P., Aldamiz-Echevarria T., Losso M., Toibaro J., Gambardella L., Moreno Macias L., Warley E., Tavella S., Garcia Messina O., Gear O., Laplume H., Marson C., Contarelia J., Michaan M., Scapellato P., Bartoletti B., Palmero D., Elias C., Cortes C., Crabtree B., Mosqueda Gomez J. L., Villanueva J. A., Gonzalez Hernandez L. A., Badial F., Kraef, C, Bentzon, A, Panteleev, A, Skrahina, A, Bolokadze, N, Tetradov, S, Podlasin, R, Karpov, I, Borodulina, E, Denisova, E, Azina, I, Lundgren, J, Johansen, I, Mocroft, A, Podlekareva, D, Kirk, O, Vassilenko, A, Klimuk, D, Kondratenko, O, Zalutskaya, A, Bondarenko, V, Mitsura, V, Kozorez, E, Tumash, O, Suetnov, O, Paduto, D, Iljina, V, Kummik, T, Mshvidobadze, K, Lanchava, N, Goginashvili, L, Mikiashvili, L, Bablishvili, N, Rozentale, B, Zeltina, I, Janushkevich, I, Caplinskiene, I, Caplinskas, S, Kancauskiene, Z, Wiercinska-Drapalo, A, Thompson, M, Kozlowska, J, Grezesczuk, A, Bura, M, Knysz, B, Inglot, M, Garlicki, A, Loster, J, Uiculescu, D, Rakhmanova, A, Panteleev, O, Yakovlev, A, Kozlov, A, Tyukalova, A, Vlasova, Y, Rofimov, T, Kyselyova, G, Obel, N, Gerstoft, J, Kronborg, G, Payen, M, Abeya, K, Necsoi, C, Dabis, F, Tsaranazy, A, Cazanave, C, Furrer, H, Sagette, M, Rickenbach, M, Sculier, D, Calmy, A, Cavassini, M, Bruno, A, Bernasconi, E, Hoffmann, M, Vernazza, P, Fehr, J, Weber, R, Miller, R, Vora, N, Cooke, G, Mullaney, S, Wilkins, E, George, V, Collini, P, Dockrell, D, Post, F, Campbell, L, Brum, R, Mabonga, E, Saigal, P, Kegg, S, Ainsworth, J, Waters, A, Dhar, J, Ellis, K, Girardi, E, Rianda, A, Galati, V, Pinnetti, C, Tommasi, C, Lapadula, G, Di Biagio, A, Parisini, A, Carbonara, S, Angarano, G, Purgatorio, M, Matteelli, A, Apostoli, A, Miro, J, Manzardo, C, Ligero, C, Gonzalez, J, Martinez-Martinez, J, Sanchez, F, Knobel, H, Salvado, M, Lopez-Colomes, J, Martinez-Lacasa, X, Cuchi, E, Falco, V, Curran, A, Tortola, M, Ocana, I, Vidal, R, Sambeat, M, Pomar, V, Coll, P, Pozamczer, D, Saumoy, M, Alcaide, F, Cayla, J, Moreno, A, Millet, J, Orcau, A, Fina, L, Romero, A, Roldan, L, Iribarren, J, Ibarguren, M, Moreno, S, Gonzalez, A, Miralles, P, Aldamiz-Echevarria, T, Losso, M, Toibaro, J, Gambardella, L, Moreno Macias, L, Warley, E, Tavella, S, Garcia Messina, O, Gear, O, Laplume, H, Marson, C, Contarelia, J, Michaan, M, Scapellato, P, Bartoletti, B, Palmero, D, Elias, C, Cortes, C, Crabtree, B, Mosqueda Gomez, J, Villanueva, J, Gonzalez Hernandez, L, Badial, F, Kraef C., Bentzon A., Panteleev A., Skrahina A., Bolokadze N., Tetradov S., Podlasin R., Karpov I., Borodulina E., Denisova E., Azina I., Lundgren J., Johansen I. S., Mocroft A., Podlekareva D., Kirk O., Vassilenko A., Klimuk D., Kondratenko O., Zalutskaya A., Bondarenko V., Mitsura V., Kozorez E., Tumash O., Suetnov O., Paduto D., Iljina V., Kummik T., Mshvidobadze K., Lanchava N., Goginashvili L., Mikiashvili L., Bablishvili N., Rozentale B., Zeltina I., Janushkevich I., Caplinskiene I., Caplinskas S., Kancauskiene Z., Wiercinska-Drapalo A., Thompson M., Kozlowska J., Grezesczuk A., Bura M., Knysz B., Inglot M., Garlicki A., Loster J., uiculescu D. D., Rakhmanova A., Panteleev O., Yakovlev A., Kozlov A., Tyukalova A., Vlasova Y., rofimov T. T., Kyselyova G., Obel N., Gerstoft J., Kronborg G., Payen M. C., abeya K. K., Necsoi C., Dabis F., Tsaranazy A., Cazanave C., Furrer H., Sagette M., Rickenbach M., Sculier D., Calmy A., Cavassini M., Bruno A., Bernasconi E., Hoffmann M., Vernazza P., Fehr J., Weber R., Miller R., Vora N., Cooke G., Mullaney S., Wilkins E., George V., Collini P., Dockrell D., Post F., Campbell L., Brum R., Mabonga E., Saigal P., Kegg S., Ainsworth J., Waters A., Dhar J., Ellis K., Girardi E., Rianda A., Galati V., Pinnetti C., Tommasi C., Lapadula G., Di Biagio A., Parisini A., Carbonara S., Angarano G., Purgatorio M., Matteelli A., Apostoli A., Miro J. M., Manzardo C., Ligero C., Gonzalez J., Martinez-Martinez J. A., Sanchez F., Knobel H., Salvado M., Lopez-Colomes J. L., Martinez-Lacasa X., Cuchi E., Falco V., Curran A., Tortola M. T., Ocana I., Vidal R., Sambeat M. A., Pomar V., Coll P., Pozamczer D., Saumoy M., Alcaide F., Cayla J., Moreno A., Millet J. P., Orcau A., Fina L., Romero A., Roldan L. L., Iribarren J. A., Ibarguren M., Moreno S., Gonzalez A., Miralles P., Aldamiz-Echevarria T., Losso M., Toibaro J., Gambardella L., Moreno Macias L., Warley E., Tavella S., Garcia Messina O., Gear O., Laplume H., Marson C., Contarelia J., Michaan M., Scapellato P., Bartoletti B., Palmero D., Elias C., Cortes C., Crabtree B., Mosqueda Gomez J. L., Villanueva J. A., Gonzalez Hernandez L. A., and Badial F.

Abstract

Background: Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods: PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan–Meier estimates and Cox models. Findings: 480/740 patients (64.9%; 95% CI 61.3–68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. < 50 years, aOR = 2.51; 1.18–5.32; p = 0.016), injecting drug use (IDU) (vs. non-IDU aOR = 1.66; 1.21–2.29; p = 0.002), being ART naïve (aOR = 1.77; 1.24–2.54; p = 0.002), disseminated TB (vs. pulmonary TB, aOR = 1.56, 1.10–2.19, p = 0.012), and presenting with weight loss (vs. no weight loss, aOR = 1.63; 1.18–2.24; p = 0.003) were associated with delayed diagnosis. PLWH with a delayed diagnosis were at 36% increased risk of death (hazard ratio = 1.36; 1.04–1.77; p = 0.023, adjusted hazard ratio 1.27; 0.95–1.70; p = 0.103). Conclusion: Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe.

Published
2021

2. Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality-a multicentre prospective cohort study

Author

Kraef, Christian, Bentzon, Adrian, Panteleev, Alexander, Skrahina, Alena, Bolokadze, Natalie, Tetradov, Simona, Podlasin, Regina, Karpov, Igor, Borodulina, Elena, Denisova, Elena, Azina, Inga, Lundgren, Jens, Johansen, Isik Somuncu, Mocroft, Amanda, Podlekareva, Daria, Kirk, Ole, Vassilenko, A., Klimuk, D., Kondratenko, O., Zalutskaya, A., Bondarenko, V., Mitsura, V., Kozorez, E., Tumash, O., Suetnov, O., Paduto, D., Iljina, V., Kummik, T., Mshvidobadze, K., Lanchava, N., Goginashvili, L., Mikiashvili, L., Bablishvili, Nino, Rozentale, B., Zeltina, I., Janushkevich, I., Caplinskiene, I., Caplinskas, S., Kancauskiene, Z., Wiercinska-Drapalo, A., Thompson, M., Kozlowska, J., Grezesczuk, A., Bura, M., Knysz, B., Inglot, M., Garlicki, A., Loster, J., uiculescu, D.D., Rakhmanova, A., Panteleev, O., Yakovlev, A., Kozlov, A., Tyukalova, A., Vlasova, Y., rofimov, T.T., Kyselyova, G., Obel, N., Gerstoft, J., Kronborg, G., Payen, M.C., abeya, K.K., Necsoi, C., Dabis, F., Tsaranazy, A., Cazanave, C., Furrer, H., Sagette, M., Rickenbach, M., Sculier, D., Calmy, A., Cavassini, Matthias, Bruno, A., Bernasconi, E., Hoffmann, M., Vernazza, P., Fehr, J., Weber, R., Miller, R., Vora, N., Cooke, G., Mullaney, S., Wilkins, E., George, V., Collini, P., Dockrell, D., Post, F., Campbell, L., Brum, R., Mabonga, E., Saigal, P., Kegg, S., Ainsworth, J., Waters, A., Dhar, J., Ellis, K., Girardi, E., Rianda, A., Galati, V., Pinnetti, C., Tommasi, C., Lapadula, G., Di Biagio, A., Parisini, A., Carbonara, S., Angarano, G., Purgatorio, M., Matteelli, A., Apostoli, A., Miro, J.M., Manzardo, C., Ligero, C., Gonzalez, J., Martinez-Martinez, J.A., Sanchez, F., Knobel Freud, Hernando, Salvadó, M., Lopez-Colomes, J.L., Martínez-Lacasa, X., Cuchí, E., Falcó, Vicenç, Curran, Adrian, Tortola, M.T., Ocaña Rivera, Immaculada, Vidal, R., Sambeat, M.A., Pomar, Virginia, Coll, P., Pozamczer, D., Saumoy, M., Alcaide, Fernando, Caylà, Joan A, Moreno Camacho, Asunción, Millet, Joan-Pau, Orcau, Àngels, Fina, L., Romero, A., Roldan, L.L., Iribarren, J.A., Ibarguren, M., Moreno, S., González, A., Miralles, P., Aldámiz-Echevarría, T., Losso, M., Toibaro, J., Gambardella, L., Moreno Macias, L., Warley, E., Tavella, S., Garcia Messina, O., Gear, O., Laplume, H., Marson, C., Contarelia, J., Michaan, M., Scapellato, P., Bartoletti, B., Palmero, D., Elias, C., Cortes, C., Crabtree, B., Mosqueda Gomez, J.L., Villanueva, J.A., Gonzalez Hernandez, L.A., Badial, F., Kraef, C, Bentzon, A, Panteleev, A, Skrahina, A, Bolokadze, N, Tetradov, S, Podlasin, R, Karpov, I, Borodulina, E, Denisova, E, Azina, I, Lundgren, J, Johansen, I, Mocroft, A, Podlekareva, D, Kirk, O, Vassilenko, A, Klimuk, D, Kondratenko, O, Zalutskaya, A, Bondarenko, V, Mitsura, V, Kozorez, E, Tumash, O, Suetnov, O, Paduto, D, Iljina, V, Kummik, T, Mshvidobadze, K, Lanchava, N, Goginashvili, L, Mikiashvili, L, Bablishvili, N, Rozentale, B, Zeltina, I, Janushkevich, I, Caplinskiene, I, Caplinskas, S, Kancauskiene, Z, Wiercinska-Drapalo, A, Thompson, M, Kozlowska, J, Grezesczuk, A, Bura, M, Knysz, B, Inglot, M, Garlicki, A, Loster, J, Uiculescu, D, Rakhmanova, A, Panteleev, O, Yakovlev, A, Kozlov, A, Tyukalova, A, Vlasova, Y, Rofimov, T, Kyselyova, G, Obel, N, Gerstoft, J, Kronborg, G, Payen, M, Abeya, K, Necsoi, C, Dabis, F, Tsaranazy, A, Cazanave, C, Furrer, H, Sagette, M, Rickenbach, M, Sculier, D, Calmy, A, Cavassini, M, Bruno, A, Bernasconi, E, Hoffmann, M, Vernazza, P, Fehr, J, Weber, R, Miller, R, Vora, N, Cooke, G, Mullaney, S, Wilkins, E, George, V, Collini, P, Dockrell, D, Post, F, Campbell, L, Brum, R, Mabonga, E, Saigal, P, Kegg, S, Ainsworth, J, Waters, A, Dhar, J, Ellis, K, Girardi, E, Rianda, A, Galati, V, Pinnetti, C, Tommasi, C, Lapadula, G, Di Biagio, A, Parisini, A, Carbonara, S, Angarano, G, Purgatorio, M, Matteelli, A, Apostoli, A, Miro, J, Manzardo, C, Ligero, C, Gonzalez, J, Martinez-Martinez, J, Sanchez, F, Knobel, H, Salvado, M, Lopez-Colomes, J, Martinez-Lacasa, X, Cuchi, E, Falco, V, Curran, A, Tortola, M, Ocana, I, Vidal, R, Sambeat, M, Pomar, V, Coll, P, Pozamczer, D, Saumoy, M, Alcaide, F, Cayla, J, Moreno, A, Millet, J, Orcau, A, Fina, L, Romero, A, Roldan, L, Iribarren, J, Ibarguren, M, Moreno, S, Gonzalez, A, Miralles, P, Aldamiz-Echevarria, T, Losso, M, Toibaro, J, Gambardella, L, Moreno Macias, L, Warley, E, Tavella, S, Garcia Messina, O, Gear, O, Laplume, H, Marson, C, Contarelia, J, Michaan, M, Scapellato, P, Bartoletti, B, Palmero, D, Elias, C, Cortes, C, Crabtree, B, Mosqueda Gomez, J, Villanueva, J, Gonzalez Hernandez, L, and Badial, F

Subjects
medicine.medical_specialty, Tuberculosis, Delayed Diagnosis, Aged, Europe, Eastern, Humans, Middle Aged, Prospective Studies, HIV Infections, Tuberculosi, Epidemiology, Tuberculosis/diagnosis, HIV Infections/complications, Infectious and parasitic diseases, RC109-216, Eastern Europe, Eastern, Logistic regression, Europa de l'Est, Medical microbiology, Weight loss, Internal medicine, medicine, VIH (Virus), HIV Infection, Europe, Eastern/epidemiology, Prospective cohort study, Epidemiologia, business.industry, Proportional hazards model, Transmission (medicine), HIV (Viruses), Research, Hazard ratio, Delayed Diagnosi, medicine.disease, Europe, Prospective Studie, Infectious Diseases, medicine.symptom, business, Human
Abstract

Background Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan–Meier estimates and Cox models. Findings 480/740 patients (64.9%; 95% CI 61.3–68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. Conclusion Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe.

Published
2021

3. Healthcare delivery for HIV-positive people with tuberculosis in Europe

Author

Bentzon, A. K., Panteleev, A., Mitsura, V., Borodulina, E., Skrahina, A., Denisova, E., Tetradov, S., Podlasin, R., Riekstina, V., Kancauskiene, Z., Paduto, D., Mocroft, A., Trofimova, T., Miller, R., Post, F., Grezesczuk, A., Lundgren, J. D., Inglot, M., Podlekareva, D., Bolokadze, N., Kirk, O., Karpov, I., Vassilenko, A., Klimuk, D., Skrahin, A., Kondratenko, O., Zalutskaya, A., Bondarenko, V., Kozorez, E., Tumash, O., Suetnov, O., Iljina, V., Kummik, T., Mshvidobadze, K., Lanchava, N., Goginashvili, L., Mikiashvili, L., Bablishvili, N., Rozentale, B., Zeltina, I., Janushkevich, I., Caplinskiene, I., Caplinskas, S., Wiercinska-Drapalo, A., Thompson, M., Kozlowska, J., Bura, M., Knysz, B., Garlicki, A., Loster, J., Duiculescu, D., Rakhmanova, A., Panteleeva, O., Yakovlev, A., Kozlov, A., Tyukalova, A., Vlasova, Y., Trofimov, T., Kyselyova, G., Obel, N., Gerstoft, J., Kronborg, G., Payen, M. C., Kabeya, K., Necsoi, C., Dabis, F., Tsaranazy, A., Cazanave, C., Furrer, H., Sagette, M., Rickenbach, M., Elzi, L., Battegay, M., Sculier, D., Calmy, A., Cavassini, M., Bruno, A., Bernasconi, E., Hoffmann, M., Vernazza, P., Fehr, J., Weber, R., Vora, N., Cooke, G., Mullaney, S., Wilkins, E., George, V., Collini, P., Dockrell, D., Campbell, L., Brum, R., Mabonga, E., Saigal, P., Kegg, S., Ainsworth, J., Waters, A., Dhar, J., Ellis, K., Spallanzani, O. L., Girardi, E., Rianda, A., Galati, V., Pinnetti, C., Tommasi, C., San Gerardo, A. O., Lapadula, G., Di Biagio, A., Parisini, A., Carbonara, S., Angarano, G., Purgatorio, M., Matteelli, A., Apostoli, A., Miro, J. M., Manzardo, C., Ligero, C., Gonzalez, J., Martinez-Martinez, J. A., Sanchez, F., Knobel, H., Salvado, M., Lopez-Colomes, J. L., Martinez-Lacasa, X., Cuchi, E., Falco, V., Curran, A., Tortola, M. T., Ocana, I., Vidal, R., Sambeat, M. A., Pomar, V., Coll, P., Pozamczer, D., Saumoy, M., Alcaide, F., Cayla, J., Moreno, A., Millet, J. P., Orcau, A., Fina, L., Romero, A., Roldan, L. L., Iribarren, J. A., Ibarguren, M., Moreno, S., Gonzalez, A., Miralles, P., Aldamiz-Echevarria, T., Losso, M., Toibaro, J., Gambardella, L., Ramos Mejia, J. M., Moreno Macias, L., Warley, E., Tavella, S., Garcia Messina, O., Gear, O., Laplume, H., Marson, C., Contarelia, J., Michaan, M., Scapellato, P., Bartoletti, B., Palmero, D., Elias, C., Cortes, C., Crabtree, B., Mosqueda Gomez, J. L., Villanueva, J. A., Gonzalez Hernandez, L. A., and Badial, F.

Subjects
0301 basic medicine, medicine.medical_specialty, Rifabutin, Tuberculosis, Tuberculosi, Epidemiology, Antitubercular Agents, HIV Infections, Article, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Moxifloxacin, Internal medicine, medicine, clinical management, VIH (Virus), Humans, Pharmacology (medical), 030212 general & internal medicine, Epidemiologia, coinfection, eastern Europe, HIV, tuberculosis, western Europe, Response rate (survey), GeneXpert MTB/RIF, business.industry, HIV (Viruses), Health Policy, medicine.disease, 030112 virology, Europe, Infectious Diseases, HIV-positive people, chemistry, Coinfection, Bedaquiline, business, Europa, Delivery of Health Care, medicine.drug
Abstract

Background: In a 2013 survey, we reported distinct discrepancies in delivery of tuberculosis (TB) and HIV services in eastern Europe (EE) vs. western Europe (WE). Objectives: To verify the differences in TB and HIV services in EE vs. WE. Methods: Twenty-three sites completed a survey in 2018 (EE, 14; WE, nine; 88% response rate). Results were compared across as well as within the two regions. When possible, results were compared with the 2013 survey. Results: Delivery of healthcare was significantly less integrated in EE: provision of TB and HIV services at one site (36% in EE vs. 89% in WE; P = 0.034), and continued TB follow-up in one location (42% vs. 100%; P = 0.007). Although access to TB diagnostics, standard TB and HIV drugs was generally good, fewer sites in EE reported unlimited access to rifabutin/multi-drug-resistant TB (MDR-TB) drugs, HIV integrase inhibitors and opioid substitution therapy (OST). Compared with 2013, routine usage of GeneXpert was more common in EE in 2018 (54% vs. 92%; P = 0.073), as was access to moxifloxacin (46% vs. 91%; P = 0.033), linezolid (31% vs. 64%; P = 0.217), and bedaquiline (0% vs. 25%; P = 0.217). Integration of TB and HIV services (46% vs. 39%; P = 1.000) and provision of OST to patients with opioid dependency (54% vs. 46%; P = 0.695) remained unchanged. Conclusion: Delivery of TB and HIV healthcare, including integration of TB and HIV care and access to MDR-TB drugs, still differs between WE and EE, as well as between individual EE sites.

Published
2020

4. Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Author

Efsen, A, Schultze, A, Miller, R, Panteleev, A, Skrahin, A, Podlekareva, D, Miro, J, Girardi, E, Furrer, H, Losso, M, Toibaro, J, Cayla, J, Mocroft, A, Lundgren, J, Post, F, Kirk, O, Karpov, I, Vassilenko, A, Skrahina, A, Klimuk, D, Kondratenko, O, Zalutskaya, A, Bondarenko, V, Mitsura, V, Kozorez, E, Tumash, O, Suetnov, O, Paduto, D, Iljina, V, Kummik, T, Bolokadze, N, Mshvidobadze, K, Lanchava, N, Goginashvili, L, Mikiashvili, L, Bablishvili, N, Rozentale, B, Zeltina, I, Janushkevich, I, Caplinskiene, I, Caplinskas, S, Kancauskiene, Z, Podlasin, R, Wiercinska-Drapalo, A, Thompson, M, Kozlowska, J, Grezesczuk, A, Bura, M, Knysz, B, Inglot, M, Garlicki, A, Loster, J, Tetradov, S, Duiculescu, D, Rakhmanova, A, Panteleeva, O, Yakovlev, A, Kozlov, A, Tyukalova, A, Vlasova, Y, Trofimov, T, Kyselyova, G, Andersen, A, Thorsteinsson, K, Payen, M, Kabeya, K, Necsoi, C, Dabis, F, Bruyand, M, Morlat, P, Dupont, A, Gerard, Y, Bonnal, F, Ceccaldi, J, De Witte, S, Monlun, E, Lataste, P, Chossat, I, Vora, N, Cooke, G, Mullaney, S, Wilkins, E, George, V, Collini, P, Dockrell, D, Campbell, L, Brum, R, Mabonga, E, Saigal, P, Kegg, S, Ainsworth, J, Waters, A, Dhar, J, Mashonganyika, L, Rianda, A, Galati, V, Pinnetti, C, Tommasi, C, Lapadula, G, Di Biagio, A, Parisini, A, Carbonara, S, Angarano, G, Purgatorio, M, Matteelli, A, Apostoli, A, Macias, L, Warley, E, Tavella, S, Garcia Messina, O, Gear, O, Laplume, H, Marson, C, Contarelia, J, Michaan, M, Scapellato, P, Alessandro, D, Bartoletti, B, Palmero, D, Elias, C, Cortes, C, Crabtree, B, Mosqueda Gomez, J, Villanueva, A, Gonzalez Hernandez, L, Efsen, AMW, Miller, RF, Podlekareva, DN, Miro, JM, Losso, MH, Cayla, JA, Lundgren, JD, Post, FA, Andersen, AB, Payen, MC, Macias, LM, Alessandro, DD, Mosqueda Gomez, JL, Gonzalez Hernandez, LA, Efsen, A, Schultze, A, Miller, R, Panteleev, A, Skrahin, A, Podlekareva, D, Miro, J, Girardi, E, Furrer, H, Losso, M, Toibaro, J, Cayla, J, Mocroft, A, Lundgren, J, Post, F, Kirk, O, Karpov, I, Vassilenko, A, Skrahina, A, Klimuk, D, Kondratenko, O, Zalutskaya, A, Bondarenko, V, Mitsura, V, Kozorez, E, Tumash, O, Suetnov, O, Paduto, D, Iljina, V, Kummik, T, Bolokadze, N, Mshvidobadze, K, Lanchava, N, Goginashvili, L, Mikiashvili, L, Bablishvili, N, Rozentale, B, Zeltina, I, Janushkevich, I, Caplinskiene, I, Caplinskas, S, Kancauskiene, Z, Podlasin, R, Wiercinska-Drapalo, A, Thompson, M, Kozlowska, J, Grezesczuk, A, Bura, M, Knysz, B, Inglot, M, Garlicki, A, Loster, J, Tetradov, S, Duiculescu, D, Rakhmanova, A, Panteleeva, O, Yakovlev, A, Kozlov, A, Tyukalova, A, Vlasova, Y, Trofimov, T, Kyselyova, G, Andersen, A, Thorsteinsson, K, Payen, M, Kabeya, K, Necsoi, C, Dabis, F, Bruyand, M, Morlat, P, Dupont, A, Gerard, Y, Bonnal, F, Ceccaldi, J, De Witte, S, Monlun, E, Lataste, P, Chossat, I, Vora, N, Cooke, G, Mullaney, S, Wilkins, E, George, V, Collini, P, Dockrell, D, Campbell, L, Brum, R, Mabonga, E, Saigal, P, Kegg, S, Ainsworth, J, Waters, A, Dhar, J, Mashonganyika, L, Rianda, A, Galati, V, Pinnetti, C, Tommasi, C, Lapadula, G, Di Biagio, A, Parisini, A, Carbonara, S, Angarano, G, Purgatorio, M, Matteelli, A, Apostoli, A, Macias, L, Warley, E, Tavella, S, Garcia Messina, O, Gear, O, Laplume, H, Marson, C, Contarelia, J, Michaan, M, Scapellato, P, Alessandro, D, Bartoletti, B, Palmero, D, Elias, C, Cortes, C, Crabtree, B, Mosqueda Gomez, J, Villanueva, A, Gonzalez Hernandez, L, Efsen, AMW, Miller, RF, Podlekareva, DN, Miro, JM, Losso, MH, Cayla, JA, Lundgren, JD, Post, FA, Andersen, AB, Payen, MC, Macias, LM, Alessandro, DD, Mosqueda Gomez, JL, and Gonzalez Hernandez, LA

Abstract

Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results 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%. Conclusions 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.

Published
2018

5. Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe

Author

Mansfeld, M, Skrahina, A, Shepherd, L, Schultze, A, Panteleev, A, Miller, R, Miro, J, Zeltina, I, Tetradov, S, Furrer, H, Kirk, O, Grzeszczuk, A, Bolokadze, N, Matteelli, A, Post, F, Lundgren, J, Mocroft, A, Efsen, A, Podlekareva, D, Losso, M, Toibaro, J, Palmero, D, Bartoletti, B, E., W, Gear, O, Messina, O, Michans, M, Laplume, H, David, D, Marson, C, Scapelatto, F, Dalessandro, D, Lupo, S, Costilla Campero, G, Herbst, M, Remondegui, C, Elias, C, Karpov, I, Vassilenko, A, Skrahina, E, Skrahin, A, Zalutskya, A, Kondratenko, O, Mitsura, V, Bondarenko, V, Suetnov, O, Paduto, D, Dewit, S, Payen, M, Noscoi, C, Kabeya, K, M., W, Cortes, C, Obel, N, Kronborg, G, Iljna, V, Kummik, T, Bryand, M, Dabis, F, Lanchava, N, Bablishvili, N, Goginashvili, L, Mikiashvili, L, Mshvidobadze, K, Girardi, E, Di Biagio, A, Apostoli, A, Barzoni, S, Lapadula, G, Purgatorio, M, Carbonara, S, Rozentale, B, Janushkevich, I, Caplinskas, S, Kancauskienne, Z, Caplinskienne, I, Crabtree, B, Pina, A, Madero, J, Mosqueda, J, Villanueva, J, Bura, M, Garlicki, A, Inglot, M, Knysz, B, Kozlowska, J, Loster, J, Mularska, E, Podlasin, R, Thompson, M, Wiercinska-Drapalo, A, Duiculescu, D, Rakhmanova, A, Yakovlev, A, Turkalova, A, Vlasova, Y, Trotimora, T, Borodulina, E, Chumanova, L, Mashkova, Y, Cayla, J, Moreno, A, Millet, J, Orcau, A, Fina, L, del Bano, L, Roldan, L, Romero, A, Martinez, J, Manzardo, C, Gonzalez, J, Tudo, G, Knobel, H, Sanchez, F, Salvado, M, Curran, A, Tortola, M, Pozamczer, D, Saumoy, M, Alcaide, F, Martinez-Lacasa, X, Cuchi, E, Sambeat, M, Pomar, V, Coll, P, Miralles, P, Moreno, S, Iribarren, J, Ibarguren, M, Aldamiz, T, Rickenbach, M, Sagette, M, Chapman, A, Dockrell, D, Wilkins, E, Cooke, G, Ainsworth, J, Macallen, D, Dhar, J, Vora, N, Mullaney, S, Kegg, S, Kyselyova, G, Mansfeld M., Skrahina A., Shepherd L., Schultze A., Panteleev A., Miller R., Miro J., Zeltina I., Tetradov S., Furrer H., Kirk O., Grzeszczuk A., Bolokadze N., Matteelli A., Post F., Lundgren J., Mocroft A., Efsen A., Podlekareva D., Losso M. H., Toibaro J. J., Palmero D., Bartoletti B. J., E. Warley, Gear O., Messina O. G., Michans M., Laplume H., David D., Marson C., Scapelatto F. P., Dalessandro D., Lupo S., Costilla Campero G., Herbst M., Remondegui C., Elias C., Karpov I., Vassilenko A., Skrahina E., Skrahin A., Zalutskya A., Kondratenko O., Mitsura V., Bondarenko V., Suetnov O., Paduto D., Dewit S., Payen M. C., Noscoi C., Kabeya K., M. Wolff, Cortes C., Obel N., Kronborg G., Iljna V., Kummik T., Bryand M., Dabis F., Lanchava N., Bablishvili N., Goginashvili L., Mikiashvili L., Mshvidobadze K., Girardi E., Di Biagio A., Apostoli A., Barzoni S., Lapadula G., Purgatorio M., Carbonara S., Rozentale B., Janushkevich I., Caplinskas S., Kancauskienne Z., Caplinskienne I., Crabtree B., Pina A., Madero J. S., Mosqueda J., Villanueva J. A., Bura M., Garlicki A., Inglot M., Knysz B., Kozlowska J., Loster J., Mularska E., Podlasin R., Thompson M., Wiercinska-Drapalo A., Duiculescu D., Rakhmanova A., Yakovlev A., Turkalova A., Vlasova Y., Trotimora T., Borodulina E., Chumanova L., Mashkova Y., Miro J. M., Cayla J. A., Moreno A., Millet J. P., Orcau A., Fina L., del Bano L., Roldan L. L., Romero A., Martinez J. A., Manzardo C., Gonzalez J., Tudo G., Knobel H., Sanchez F., Salvado M., Curran A., Tortola M. T., Pozamczer D., Saumoy M., Alcaide F., Martinez-Lacasa X., Cuchi E., Sambeat M. A., Pomar V., Coll P., Miralles P., Moreno S., Iribarren J. A., Ibarguren M., Aldamiz T., Rickenbach M., Sagette M., Post F. A., Miller R. F., Chapman A., Dockrell D., Wilkins E., Cooke G., Ainsworth J., Macallen D., Dhar J., Vora N., Mullaney S., Kegg S., Kyselyova G., Mansfeld, M, Skrahina, A, Shepherd, L, Schultze, A, Panteleev, A, Miller, R, Miro, J, Zeltina, I, Tetradov, S, Furrer, H, Kirk, O, Grzeszczuk, A, Bolokadze, N, Matteelli, A, Post, F, Lundgren, J, Mocroft, A, Efsen, A, Podlekareva, D, Losso, M, Toibaro, J, Palmero, D, Bartoletti, B, E., W, Gear, O, Messina, O, Michans, M, Laplume, H, David, D, Marson, C, Scapelatto, F, Dalessandro, D, Lupo, S, Costilla Campero, G, Herbst, M, Remondegui, C, Elias, C, Karpov, I, Vassilenko, A, Skrahina, E, Skrahin, A, Zalutskya, A, Kondratenko, O, Mitsura, V, Bondarenko, V, Suetnov, O, Paduto, D, Dewit, S, Payen, M, Noscoi, C, Kabeya, K, M., W, Cortes, C, Obel, N, Kronborg, G, Iljna, V, Kummik, T, Bryand, M, Dabis, F, Lanchava, N, Bablishvili, N, Goginashvili, L, Mikiashvili, L, Mshvidobadze, K, Girardi, E, Di Biagio, A, Apostoli, A, Barzoni, S, Lapadula, G, Purgatorio, M, Carbonara, S, Rozentale, B, Janushkevich, I, Caplinskas, S, Kancauskienne, Z, Caplinskienne, I, Crabtree, B, Pina, A, Madero, J, Mosqueda, J, Villanueva, J, Bura, M, Garlicki, A, Inglot, M, Knysz, B, Kozlowska, J, Loster, J, Mularska, E, Podlasin, R, Thompson, M, Wiercinska-Drapalo, A, Duiculescu, D, Rakhmanova, A, Yakovlev, A, Turkalova, A, Vlasova, Y, Trotimora, T, Borodulina, E, Chumanova, L, Mashkova, Y, Cayla, J, Moreno, A, Millet, J, Orcau, A, Fina, L, del Bano, L, Roldan, L, Romero, A, Martinez, J, Manzardo, C, Gonzalez, J, Tudo, G, Knobel, H, Sanchez, F, Salvado, M, Curran, A, Tortola, M, Pozamczer, D, Saumoy, M, Alcaide, F, Martinez-Lacasa, X, Cuchi, E, Sambeat, M, Pomar, V, Coll, P, Miralles, P, Moreno, S, Iribarren, J, Ibarguren, M, Aldamiz, T, Rickenbach, M, Sagette, M, Chapman, A, Dockrell, D, Wilkins, E, Cooke, G, Ainsworth, J, Macallen, D, Dhar, J, Vora, N, Mullaney, S, Kegg, S, Kyselyova, G, Mansfeld M., Skrahina A., Shepherd L., Schultze A., Panteleev A., Miller R., Miro J., Zeltina I., Tetradov S., Furrer H., Kirk O., Grzeszczuk A., Bolokadze N., Matteelli A., Post F., Lundgren J., Mocroft A., Efsen A., Podlekareva D., Losso M. H., Toibaro J. J., Palmero D., Bartoletti B. J., E. Warley, Gear O., Messina O. G., Michans M., Laplume H., David D., Marson C., Scapelatto F. P., Dalessandro D., Lupo S., Costilla Campero G., Herbst M., Remondegui C., Elias C., Karpov I., Vassilenko A., Skrahina E., Skrahin A., Zalutskya A., Kondratenko O., Mitsura V., Bondarenko V., Suetnov O., Paduto D., Dewit S., Payen M. C., Noscoi C., Kabeya K., M. Wolff, Cortes C., Obel N., Kronborg G., Iljna V., Kummik T., Bryand M., Dabis F., Lanchava N., Bablishvili N., Goginashvili L., Mikiashvili L., Mshvidobadze K., Girardi E., Di Biagio A., Apostoli A., Barzoni S., Lapadula G., Purgatorio M., Carbonara S., Rozentale B., Janushkevich I., Caplinskas S., Kancauskienne Z., Caplinskienne I., Crabtree B., Pina A., Madero J. S., Mosqueda J., Villanueva J. A., Bura M., Garlicki A., Inglot M., Knysz B., Kozlowska J., Loster J., Mularska E., Podlasin R., Thompson M., Wiercinska-Drapalo A., Duiculescu D., Rakhmanova A., Yakovlev A., Turkalova A., Vlasova Y., Trotimora T., Borodulina E., Chumanova L., Mashkova Y., Miro J. M., Cayla J. A., Moreno A., Millet J. P., Orcau A., Fina L., del Bano L., Roldan L. L., Romero A., Martinez J. A., Manzardo C., Gonzalez J., Tudo G., Knobel H., Sanchez F., Salvado M., Curran A., Tortola M. T., Pozamczer D., Saumoy M., Alcaide F., Martinez-Lacasa X., Cuchi E., Sambeat M. A., Pomar V., Coll P., Miralles P., Moreno S., Iribarren J. A., Ibarguren M., Aldamiz T., Rickenbach M., Sagette M., Post F. A., Miller R. F., Chapman A., Dockrell D., Wilkins E., Cooke G., Ainsworth J., Macallen D., Dhar J., Vora N., Mullaney S., Kegg S., and Kyselyova G.

Abstract

Objectives: The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE). Methods: Thirty-eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study. Results: Respondent centres in EE comprised: Belarus (n=3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P<0.001) and less often provided by the same doctors (41% versus 90%, respectively; P=0.002), whereas regular screening of HIV-infected patients for TB (80% versus 40%, respectively; P=0.037) and directly observed treatment (88% versus 20%, respectively; P<0.001) were more common in EE. The reported availability of rifabutin and second- and third-line anti-TB drugs was lower, and opioid substitution therapy (OST) was available at fewer centres in EE compared with WE (53% versus 100%, respectively; P<0.001). Conclusions: Major differences exist between EE and WE in relation to the organization and delivery of health care for HIV/TB-coinfected patients and the availability of anti-TB drugs and OST. Significant discrepancies between reported and actual clinical practices were found in EE.

Published
2015

6. Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe

Author

Mansfeld M., Skrahina A., Shepherd L., Schultze A., Panteleev A., Miller R., Miro J., Zeltina I., Tetradov S., Furrer H., Kirk O., Grzeszczuk A., Bolokadze N., Matteelli A., Post F., Lundgren J., Mocroft A., Efsen A., Podlekareva D., Losso M. H., Toibaro J. J., Palmero D., Bartoletti B. J., E. Warley, Gear O., Messina O. G., Michans M., Laplume H., David D., Marson C., Scapelatto F. P., Dalessandro D., Lupo S., Costilla Campero G., Herbst M., Remondegui C., Elias C., Karpov I., Vassilenko A., Skrahina E., Skrahin A., Zalutskya A., Kondratenko O., Mitsura V., Bondarenko V., Suetnov O., Paduto D., Dewit S., Payen M. C., Noscoi C., Kabeya K., M. Wolff, Cortes C., Obel N., Kronborg G., Iljna V., Kummik T., Bryand M., Dabis F., Lanchava N., Bablishvili N., Goginashvili L., Mikiashvili L., Mshvidobadze K., Girardi E., Di Biagio A., Apostoli A., Barzoni S., Lapadula G., Purgatorio M., Carbonara S., Rozentale B., Janushkevich I., Caplinskas S., Kancauskienne Z., Caplinskienne I., Crabtree B., Pina A., Madero J. S., Mosqueda J., Villanueva J. A., Bura M., Garlicki A., Inglot M., Knysz B., Kozlowska J., Loster J., Mularska E., Podlasin R., Thompson M., Wiercinska-Drapalo A., Duiculescu D., Rakhmanova A., Yakovlev A., Turkalova A., Vlasova Y., Trotimora T., Borodulina E., Chumanova L., Mashkova Y., Miro J. M., Cayla J. A., Moreno A., Millet J. P., Orcau A., Fina L., del Bano L., Roldan L. L., Romero A., Martinez J. A., Manzardo C., Gonzalez J., Tudo G., Knobel H., Sanchez F., Salvado M., Curran A., Tortola M. T., Pozamczer D., Saumoy M., Alcaide F., Martinez-Lacasa X., Cuchi E., Sambeat M. A., Pomar V., Coll P., Miralles P., Moreno S., Iribarren J. A., Ibarguren M., Aldamiz T., Rickenbach M., Sagette M., Post F. A., Miller R. F., Chapman A., Dockrell D., Wilkins E., Cooke G., Ainsworth J., Macallen D., Dhar J., Vora N., Mullaney S., Kegg S., Kyselyova G., Mansfeld, M, Skrahina, A, Shepherd, L, Schultze, A, Panteleev, A, Miller, R, Miro, J, Zeltina, I, Tetradov, S, Furrer, H, Kirk, O, Grzeszczuk, A, Bolokadze, N, Matteelli, A, Post, F, Lundgren, J, Mocroft, A, Efsen, A, Podlekareva, D, Losso, M, Toibaro, J, Palmero, D, Bartoletti, B, E., W, Gear, O, Messina, O, Michans, M, Laplume, H, David, D, Marson, C, Scapelatto, F, Dalessandro, D, Lupo, S, Costilla Campero, G, Herbst, M, Remondegui, C, Elias, C, Karpov, I, Vassilenko, A, Skrahina, E, Skrahin, A, Zalutskya, A, Kondratenko, O, Mitsura, V, Bondarenko, V, Suetnov, O, Paduto, D, Dewit, S, Payen, M, Noscoi, C, Kabeya, K, M., W, Cortes, C, Obel, N, Kronborg, G, Iljna, V, Kummik, T, Bryand, M, Dabis, F, Lanchava, N, Bablishvili, N, Goginashvili, L, Mikiashvili, L, Mshvidobadze, K, Girardi, E, Di Biagio, A, Apostoli, A, Barzoni, S, Lapadula, G, Purgatorio, M, Carbonara, S, Rozentale, B, Janushkevich, I, Caplinskas, S, Kancauskienne, Z, Caplinskienne, I, Crabtree, B, Pina, A, Madero, J, Mosqueda, J, Villanueva, J, Bura, M, Garlicki, A, Inglot, M, Knysz, B, Kozlowska, J, Loster, J, Mularska, E, Podlasin, R, Thompson, M, Wiercinska-Drapalo, A, Duiculescu, D, Rakhmanova, A, Yakovlev, A, Turkalova, A, Vlasova, Y, Trotimora, T, Borodulina, E, Chumanova, L, Mashkova, Y, Cayla, J, Moreno, A, Millet, J, Orcau, A, Fina, L, del Bano, L, Roldan, L, Romero, A, Martinez, J, Manzardo, C, Gonzalez, J, Tudo, G, Knobel, H, Sanchez, F, Salvado, M, Curran, A, Tortola, M, Pozamczer, D, Saumoy, M, Alcaide, F, Martinez-Lacasa, X, Cuchi, E, Sambeat, M, Pomar, V, Coll, P, Miralles, P, Moreno, S, Iribarren, J, Ibarguren, M, Aldamiz, T, Rickenbach, M, Sagette, M, Chapman, A, Dockrell, D, Wilkins, E, Cooke, G, Ainsworth, J, Macallen, D, Dhar, J, Vora, N, Mullaney, S, Kegg, S, and Kyselyova, G

Subjects
Tuberculosi, Coinfection, Health Policy, Antitubercular Agents, HIV, 1103 Clinical Sciences, HIV Infections, Eastern, Health Surveys, Article, Europe, Infectious Diseases, Cross-Sectional Studies, Rifabutin, Delivery of health care, Integrated, Tuberculosis, Europe, Eastern, Humans, Opiate Substitution Treatment, Pharmacology (medical), Virology, 610 Medicine & health
Abstract

Objectives: The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE). Methods: Thirty-eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study. Results: Respondent centres in EE comprised: Belarus (n=3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P

Published
2015

7. Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Author

Efsen, A.M.W., primary, Schultze, A., additional, Miller, R.F., additional, Panteleev, A., additional, Skrahin, A., additional, Podlekareva, D.N., additional, Miro, J.M., additional, Girardi, E., additional, Furrer, H., additional, Losso, M.H., additional, Toibaro, J., additional, Caylà, J.A., additional, Mocroft, A., additional, Lundgren, J.D., additional, Post, F.A., additional, Kirk, O., additional, Karpov, I., additional, Vassilenko, A., additional, Skrahina, A., additional, Klimuk, D., additional, Kondratenko, O., additional, Zalutskaya, A., additional, Bondarenko, V., additional, Mitsura, V., additional, Kozorez, E., additional, Tumash, O., additional, Suetnov, O., additional, Paduto, D., additional, Iljina, V., additional, Kummik, T., additional, Bolokadze, N., additional, Mshvidobadze, K., additional, Lanchava, N., additional, Goginashvili, L., additional, Mikiashvili, L., additional, Bablishvili, N., additional, Rozentale, B., additional, Zeltina, I., additional, Janushkevich, I., additional, Caplinskiene, I., additional, Caplinskas, S., additional, Kancauskiene, Z., additional, Podlasin, R., additional, Wiercinska-Drapalo, A., additional, Thompson, M., additional, Kozlowska, J., additional, Grezesczuk, A., additional, Bura, M., additional, Knysz, B., additional, Inglot, M., additional, Garlicki, A., additional, Loster, J., additional, Tetradov, S., additional, Duiculescu, D., additional, Rakhmanova, A., additional, Panteleeva, O., additional, Yakovlev, A., additional, Kozlov, A., additional, Tyukalova, A., additional, Vlasova, Y., additional, Trofimov, T., additional, Kyselyova, G., additional, Andersen, A.B., additional, Thorsteinsson, K., additional, Payen, M.C., additional, Kabeya, K., additional, Necsoi, C., additional, Dabis, F., additional, Bruyand, M., additional, Morlat, P., additional, Dupont, A., additional, Gerard, Y., additional, Bonnal, F., additional, Ceccaldi, J., additional, De Witte, S., additional, Monlun, E., additional, Lataste, P., additional, Chossat, I., additional, Miller, R., additional, Vora, N., additional, Cooke, G., additional, Mullaney, S., additional, Wilkins, E., additional, George, V., additional, Collini, P., additional, Dockrell, D., additional, Post, F., additional, Campbell, L., additional, Brum, R., additional, Mabonga, E., additional, Saigal, P., additional, Kegg, S., additional, Ainsworth, J., additional, Waters, A., additional, Dhar, J., additional, Mashonganyika, L., additional, Rianda, A., additional, Galati, V., additional, Pinnetti, C., additional, Tommasi, C., additional, Lapadula, G., additional, Di Biagio, A., additional, Parisini, A., additional, Carbonara, S., additional, Angarano, G., additional, Purgatorio, M., additional, Matteelli, A., additional, Apostoli, A., additional, Macias, L. Moreno, additional, Warley, E., additional, Tavella, S., additional, Garcia Messina, O., additional, Gear, O., additional, Laplume, H., additional, Marson, C., additional, Contarelia, J., additional, Michaan, M., additional, Scapellato, P., additional, Alessandro, D.D., additional, Bartoletti, B., additional, Palmero, D., additional, Elias, C., additional, Cortes, C., additional, Crabtree, B., additional, Mosqueda Gomez, J.L., additional, Villanueva, A., additional, and Gonzalez Hernandez, L.A., additional

Published
2018
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8. Tuberculosis-related mortality in people living with HIV in Europe and Latin America: An international cohort study

Author

Podlekareva Daria, N, Efsen Anne Marie, W, Schultze, A, Post Frank, A, Skrahina Alena, M, Panteleev, A, Furrer, H, Miller Robert, F, Losso, M. H, Toibaro, J, Miro Jose, M, Vassilenko, A, Girardi, Enrico, Bruyand, M, Obel, N, Lundgren Jens, D, Mocroft, A, Kirk, O, Karpov, I, Skrahina, A, Klimuk, D, Skrahin, A, Kondratenko, O, Zalutskaya, A, Bondarenko, V, Mitsura, V, Kozorez, E, Tumash, O, Suetnov, O, Paduto, D, Iljina, V, Kummik, T, Bolokadze, N, Mshvidobadze, K, Lanchava, N, Goginashvili, L, Mikiashvili, L, Bablishvili, N, Rozentale, B, Zeltina, I, Janushkevich, I, Caplinskiene, I, Caplinskas, S, Kancauskiene, Z, Podlasin, R, Wiercinska Drapalo, A, Thompson, M, Kozlowska, J, Grezesczuk, A, Bura, M, Knysz, B, Inglot, M, Garlicki, A, Loster, J, Duiculescu, D, Tetradov, S, Rakhmanova, A, Panteleeva, O, Yakovlev, A, Kozlov, A, Tyukalova, A, Vlasova, Y, Trofimov, T, Kyselyova, G, Thorsteinsson, K, Payen, Mc, Kabeya, K, Necsoi, C, Dabis, F, Morlat, P, Dupont, A, Gerard, Y, Bonnal, F, Ceccaldi, J, De Witte, S, Monlun, E, Lataste, P, Chossat, I, Sagette, M, Rickenbach, M, Elzi, L, Battegay, M, Sculier, D, Calmy, A, Cavassini, M, Bruno, A, Bernasconi, E, Hoffmann, M, Vernazza, P, Fehr, J, Weber, R, Aubert, V, Böni, J, Bucher, Hc, Burton Jeangros, C, Dollenmaier, G, Egger, M, Fellay, J, Fux, Ca, Gorgievski, M, Günthard, H, Haerry, D, Hasse, B, Hirsch, Hh, Hösli, I, Kahlert, C, Kaiser, L, Keiser, O, Klimkait, T, Kouyos, R, Kovari, H, Ledergerber, B, Martinetti, G, Martinez de Tejada, B, Metzner, K, Müller, N, Nadal, D, Nicca, D, Pantaleo, G, Rauch, A, Regenass, S, Rudin, C, Schöni Affolter, F, Schmid, P, Schüpbach, J, Speck, R, Tarr, P, Telenti, A, Trkola, A, Yerly, S, Miller, Rf, Vora, N, Cooke, G, Mullaney, S, Wilkins, E, George, V, Collini, P, Dockrell, D, Post, F, Campbell, L, Brum, R, Mabonga, E, Saigal, P, Kegg, S, Ainsworth, J, Waters, A, Dhar, J, Mashonganyika, L, Girardi, E, Rianda, A, Galati, V, Pinnetti, C, Tommasi, C, Lapadula, G, Di Biagio, A, Parisini, A, Carbonara, S, Angarano, G, Purgatorio, M, Matteelli, Alberto, Apostoli, A, Miro, Jm, Manzardo, C, Ligero, C, Gonzalez, J, Martinez Martinez, Ja, Sanchez, F, Knobel, H, Salvadó, M, Lopez Colomes, Jl, Martínez Lacasa, X, Cuchí, E, Falcó, V, Curran, A, Tortola, Mt, Ocaña, I, Vidal, R, Sambeat, Ma, Pomar, V, Coll, P, Pozamczer, D, Saumoy, M, Alcaide, F, Caylà, J, Moreno, A, Millet, Jp, Orcau, A, Fina, L, Romero, A, Roldan, Ll, Iribarren, Ja, Ibarguren, M, Moreno, S, González, A, Miralles, P, Aldámiz Echevarría, T, Losso, M, Gambardella, L, Macias, L, Warley, E, Tavella, S, Messina, O, Gear, O, Laplume, H, Marson, C, Contarelia, J, Michaan, M, Scapellato, P, Alessandro, D, Bartoletti, B, Palmero, D, Elias, C, Cortes, C, Crabtree, B, Gomez, Jl, Hernandez, La, and Badial, F.

Subjects
Adult, Male, 0301 basic medicine, Pediatrics, medicine.medical_specialty, Latin Americans, Tuberculosis, Anti-HIV Agents, Epidemiology, 030106 microbiology, Population, Infectious Diseases, Immunology, Virology, Antitubercular Agents, HIV Infections, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Tuberculosis, Multidrug-Resistant, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Young adult, Epidemics, education, Prospective cohort study, education.field_of_study, AIDS-Related Opportunistic Infections, business.industry, Mortality rate, Middle Aged, medicine.disease, Europe, Latin America, Female, business, Developed country, Demography, Cohort study
Abstract

Management of tuberculosis in patients with HIV in eastern Europe is complicated by the high prevalence of multidrug-resistant tuberculosis, low rates of drug susceptibility testing, and poor access to antiretroviral therapy (ART). We report 1 year mortality estimates from a multiregional (eastern Europe, western Europe, and Latin America) prospective cohort study: the TB:HIV study.Consecutive HIV-positive patients aged 16 years or older with a diagnosis of tuberculosis between Jan 1, 2011, and Dec 31, 2013, were enrolled from 62 HIV and tuberculosis clinics in 19 countries in eastern Europe, western Europe, and Latin America. The primary endpoint was death within 12 months after starting tuberculosis treatment; all deaths were classified according to whether or not they were tuberculosis related. Follow-up was either until death, the final visit, or 12 months after baseline, whichever occurred first. Risk factors for all-cause and tuberculosis-related deaths were assessed using Kaplan-Meier estimates and Cox models.Of 1406 patients (834 in eastern Europe, 317 in western Europe, and 255 in Latin America), 264 (19%) died within 12 months. 188 (71%) of these deaths were tuberculosis related. The probability of all-cause death was 29% (95% CI 26-32) in eastern Europe, 4% (3-7) in western Europe, and 11% (8-16) in Latin America (p0·0001) and the corresponding probabilities of tuberculosis-related death were 23% (20-26), 1% (0-3), and 4% (2-8), respectively (p0·0001). Patients receiving care outside eastern Europe had a 77% decreased risk of death: adjusted hazard ratio (aHR) 0·23 (95% CI 0·16-0·31). In eastern Europe, compared with patients who started a regimen with at least three active antituberculosis drugs, those who started fewer than three active antituberculosis drugs were at a higher risk of tuberculosis-related death (aHR 3·17; 95% CI 1·83-5·49) as were those who did not have baseline drug-susceptibility tests (2·24; 1·31-3·83). Other prognostic factors for increased tuberculosis-related mortality were disseminated tuberculosis and a low CD4 cell count. 18% of patients were receiving ART at tuberculosis diagnosis in eastern Europe compared with 44% in western Europe and 39% in Latin America (p0·0001); 12 months later the proportions were 67% in eastern Europe, 92% in western Europe, and 85% in Latin America (p0·0001).Patients with HIV and tuberculosis in eastern Europe have a risk of death nearly four-times higher than that in patients from western Europe and Latin America. This increased mortality rate is associated with modifiable risk factors such as lack of drug susceptibility testing and suboptimal initial antituberculosis treatment in settings with a high prevalence of drug resistance. Urgent action is needed to improve tuberculosis care for patients living with HIV in eastern Europe.EU Seventh Framework Programme.

Published
2016

9. Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Author

A.M.W. Efsen, A. Schultze, R.F. Miller, A. Panteleev, A. Skrahin, D.N. Podlekareva, J.M. Miro, E. Girardi, H. Furrer, M.H. Losso, J. Toibaro, J.A. Caylà, A. Mocroft, J.D. Lundgren, F.A. Post, O. Kirk, I. Karpov, A. Vassilenko, A. Skrahina, D. Klimuk, O. Kondratenko, A. Zalutskaya, V. Bondarenko, V. Mitsura, E. Kozorez, O. Tumash, O. Suetnov, D. Paduto, V. Iljina, T. Kummik, N. Bolokadze, K. Mshvidobadze, N. Lanchava, L. Goginashvili, L. Mikiashvili, N. Bablishvili, B. Rozentale, I. Zeltina, I. Janushkevich, I. Caplinskiene, S. Caplinskas, Z. Kancauskiene, R. Podlasin, A. Wiercinska-Drapalo, M. Thompson, J. Kozlowska, A. Grezesczuk, M. Bura, B. Knysz, M. Inglot, A. Garlicki, J. Loster, S. Tetradov, D. Duiculescu, A. Rakhmanova, O. Panteleeva, A. Yakovlev, A. Kozlov, A. Tyukalova, Y. Vlasova, T. Trofimov, G. Kyselyova, A.B. Andersen, K. Thorsteinsson, M.C. Payen, K. Kabeya, C. Necsoi, F. Dabis, M. Bruyand, P. Morlat, A. Dupont, Y. Gerard, F. Bonnal, J. Ceccaldi, S. De Witte, E. Monlun, P. Lataste, I. Chossat, R. Miller, N. Vora, G. Cooke, S. Mullaney, E. Wilkins, V. George, P. Collini, D. Dockrell, F. Post, L. Campbell, R. Brum, E. Mabonga, P. Saigal, S. Kegg, J. Ainsworth, A. Waters, J. Dhar, L. Mashonganyika, A. Rianda, V. Galati, C. Pinnetti, C. Tommasi, G. Lapadula, A. Di Biagio, A. Parisini, S. Carbonara, G. Angarano, M. Purgatorio, A. Matteelli, A. Apostoli, L. Moreno Macias, E. Warley, S. Tavella, O. Garcia Messina, O. Gear, H. Laplume, C. Marson, J. Contarelia, M. Michaan, P. Scapellato, D.D. Alessandro, B. Bartoletti, D. Palmero, C. Elias, C. Cortes, B. Crabtree, J.L. Mosqueda Gomez, A. Villanueva, L.A. Gonzalez Hernandez, Universitat de Barcelona, Efsen, A, Schultze, A, Miller, R, Panteleev, A, Skrahin, A, Podlekareva, D, Miro, J, Girardi, E, Furrer, H, Losso, M, Toibaro, J, Cayla, J, Mocroft, A, Lundgren, J, Post, F, Kirk, O, Karpov, I, Vassilenko, A, Skrahina, A, Klimuk, D, Kondratenko, O, Zalutskaya, A, Bondarenko, V, Mitsura, V, Kozorez, E, Tumash, O, Suetnov, O, Paduto, D, Iljina, V, Kummik, T, Bolokadze, N, Mshvidobadze, K, Lanchava, N, Goginashvili, L, Mikiashvili, L, Bablishvili, N, Rozentale, B, Zeltina, I, Janushkevich, I, Caplinskiene, I, Caplinskas, S, Kancauskiene, Z, Podlasin, R, Wiercinska-Drapalo, A, Thompson, M, Kozlowska, J, Grezesczuk, A, Bura, M, Knysz, B, Inglot, M, Garlicki, A, Loster, J, Tetradov, S, Duiculescu, D, Rakhmanova, A, Panteleeva, O, Yakovlev, A, Kozlov, A, Tyukalova, A, Vlasova, Y, Trofimov, T, Kyselyova, G, Andersen, A, Thorsteinsson, K, Payen, M, Kabeya, K, Necsoi, C, Dabis, F, Bruyand, M, Morlat, P, Dupont, A, Gerard, Y, Bonnal, F, Ceccaldi, J, De Witte, S, Monlun, E, Lataste, P, Chossat, I, Vora, N, Cooke, G, Mullaney, S, Wilkins, E, George, V, Collini, P, Dockrell, D, Campbell, L, Brum, R, Mabonga, E, Saigal, P, Kegg, S, Ainsworth, J, Waters, A, Dhar, J, Mashonganyika, L, Rianda, A, Galati, V, Pinnetti, C, Tommasi, C, Lapadula, G, Di Biagio, A, Parisini, A, Carbonara, S, Angarano, G, Purgatorio, M, Matteelli, A, Apostoli, A, Macias, L, Warley, E, Tavella, S, Garcia Messina, O, Gear, O, Laplume, H, Marson, C, Contarelia, J, Michaan, M, Scapellato, P, Alessandro, D, Bartoletti, B, Palmero, D, Elias, C, Cortes, C, Crabtree, B, Mosqueda Gomez, J, Villanueva, A, and Gonzalez Hernandez, L

Subjects
Male, Pediatrics, Art initiation, Antitubercular Agents, Human immunodeficiency virus (HIV), HIV Infections, Hiv management, Eastern, medicine.disease_cause, Cohort Studies, 0302 clinical medicine, Antiretroviral Therapy, Highly Active, Tuberculosis, Multidrug-Resistant, Health care, Medicine, Europe, Eastern, Prospective Studies, 030212 general & internal medicine, Viral suppression, Prospective cohort study, Coinfection, Disease Management, Multidrug-Resistant, 3. Good health, Europe, Infectious Diseases, Female, Eastern Europe, HIV, MDR-TB, Tuberculosis, Microbiology (medical), Viral load, HIV infections, Adult, medicine.medical_specialty, Anti-HIV Agents, Tuberculosi, Antiretroviral Therapy, Article, 03 medical and health sciences, Humans, Highly Active, business.industry, medicine.disease, 030228 respiratory system, Infeccions per VIH, business
Abstract

Summary Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results 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%. Conclusions 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.

Published
2017

10. Transforming growth factor-β, Interleukin-23 and interleukin-1β modulate TH22 response during active multidrug-resistant tuberculosis.

Author

Imperiale BR, Gamberale A, Yokobori N, García A, Bartoletti B, Aidar O, López B, Cruz V, González Montaner P, Palmero DJ, and de la Barrera S

Subjects
Humans, Transforming Growth Factor beta metabolism, Interleukin-23, Leukocytes, Mononuclear metabolism, Interleukin-1beta, Programmed Cell Death 1 Receptor, Transforming Growth Factors, Tuberculosis, Multidrug-Resistant drug therapy, Mycobacterium tuberculosis
Abstract

We previously reported that patients with multidrug-resistant tuberculosis (MDR-TB) showed low systemic and Mtb-induced Th22 responses associated to high sputum bacillary load and severe lung lesions suggesting that Th22 response could influence the ability of these patients to control bacillary growth and tissue damage. In MDR-TB patients, the percentage of IL-22 + cells inversely correlates with the proportion of senescent PD-1 + T cells. Herein, we aimed to evaluate the pathways involved on the regulation of systemic and Mtb-induced Th22 response in MDR-TB and fully drug-susceptible TB patients (S-TB) and healthy donors. Our results show that while IL-1β and IL-23 promote Mtb-induced IL-22 secretion and expansion of IL-22 + cells, TGF-β inhibits this response. Systemic and in vitro Mtb-induced Th22 response inversely correlates with TGF-β amounts in plasma and in PBMC cultures respectively. The number of circulating PD-1 + T cells directly correlates with plasmatic TGF-β levels and blockade of PD-1/PD-L1 signalling enhances in vitro Mtb-induced expansion of IL-22 + cells. Thus, TGF-β could also inhibit Th22 response through upregulation of PD-1 expression in T cells. Higher percentage of IL-23 + monocytes was observed in TB patients. In contrast, the proportion of IL-1β + monocytes was lower in TB patients with bilateral lung cavities (BCC) compared to those patients with unilateral cavities (UCC). Interestingly, TB patients with BCC showed higher plasmatic and Mtb-induced TGF-β secretion than patients with UCC. Thus, high TGF-β secretion and subtle differences in IL-23 and IL-1β expression could diminish systemic and in vitro Mtb-induced Th22 response along disease progression in TB patients., (© 2023 John Wiley & Sons Ltd.)

Published
2024
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11. [An emerging problem: heteroresistance in Mycobacterium tuberculosis].

Author

Gamberale A, Bartoletti B, Cruz V, Matteo M, Latini C, Paul R, Lorenzo F, Símboli N, and Palmero D

Subjects
Humans, Mutation, Antitubercular Agents therapeutic use, Mycobacterium tuberculosis genetics, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Multidrug-Resistant drug therapy, Tuberculosis, Multidrug-Resistant microbiology, Acquired Immunodeficiency Syndrome
Abstract

Mixed infection by Mycobacterium tuberculosis (Mtb) consists in the simultaneous coexistence in the same patient of two different strains of Mtb or 2 different variants of the same strain. When one of the variants selects for resistance mutations, it is called monoclonal heteroresistance (HTR); if there are 2 different strains, one sensitive and one resistant (or with different resistance patterns), it is called polyclonal HTR. Three cases of HIV/AIDS patients are presented, all with repeated treatment adherence problems, in whom monoclonal HTR was diagnosed through Mtb complete genomic sequentiation with the coexistence of two variants of the same strain isolated from samples from lung and lymph nodes, with different resistance profiles in each case. It is important to consider the possibility of HTR, especially in patients with multiple previous therapeutic attempts and high bacillary populations, such as in advanced AIDS, since this situation potentially compromises treatment results by coexisting sensitive and resistant variants of a strain (or strains).

Published
2023

12. [Job's syndrome and miliary tuberculosis].

Author

Gamberale A, Moreira I, Bartoletti B, Cruz V, Bezrodnik L, Alberti F, Catro Zorrilla L, and Palmero D

Subjects
Humans, Immunoglobulin Isotypes blood, Male, STAT3 Transcription Factor genetics, Tuberculosis, Miliary drug therapy, Young Adult, Immunoglobulin E blood, Job Syndrome complications, Tuberculosis, Miliary complications
Abstract

The hyper Immunoglobulin E syndrome, also known as Job's syndrome, is a rare primary immunodeficiency, its mechanisms of inheritance maybe recessive or dominant autosomal. It is characterized by high levels of IgE, eosinophilia, skin abscesses, eczema, chronic mucocutaneous candidiasis and recurrent pulmonary infections all of which contribute to the development of pneumatoceles and bronchiectasis. The most frequently isolated bacteria is Staphylococcus aureus. Currently, despite the highest survival of patients, lymphomas and other opportunistic infections have been reported. There are few reports of patients with Mycobacterium tuberculosis infection associated with hyper IgE syndrome. Therefore it is relevant that we report a case history of a patient with pulmonary tuberculosis, presenting miliary tuberculosis and severe respiratory compromise, who responded positively to standard anti-tuberculous treatment with first line drugs.

Published
2014

13. [Hepatosplenic candidiasis in acute myeloid leukemia].

Author

Larregina A, Bartoletti B, Romano H, Paniccia L, and Polini NN

Subjects
Adult, Amphotericin B administration & dosage, Amphotericin B therapeutic use, Antifungal Agents administration & dosage, Antifungal Agents therapeutic use, Antineoplastic Combined Chemotherapy Protocols adverse effects, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Candidiasis drug therapy, Deoxycholic Acid administration & dosage, Deoxycholic Acid therapeutic use, Drug Combinations, Early Diagnosis, Fever etiology, Hepatomegaly drug therapy, Humans, Immunocompromised Host, Leukemia, Myeloid, Acute drug therapy, Liposomes administration & dosage, Male, Neutropenia chemically induced, Neutropenia complications, Splenomegaly drug therapy, Candidiasis etiology, Hepatomegaly microbiology, Leukemia, Myeloid, Acute complications, Splenomegaly microbiology
Abstract

Chronic diseminated candidiasis--mainly its hepatosplenic form- is one of the most characteristic invasive infection due to Candida in haematological patients. A case is presented of a 31 year old man admitted to the Clinical Department with acute mieloid leukosis M2, showing febrile neutropenia after induction and consolidation chemotherapy. Hepatoesplenic candidiasis was diagnosed and confirmed by computered axial tomography (CAT) and hepatic biopsy; amphotericin B followed by liposome encapsuled amphotericin B up to complete a total dose of 4 g was used for treatment. The patient was discharged waiting for bone marrow transplantation. Early suspicion of hepatosplenic candidiasis helps to select a rapid diagnosis method and an effective treatment.

Published
2004

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