Tuberculosis treatment outcomes in HIV co-infected patients in Novokuznetsk, Russian Federation

The aim was to examine treatment results among new tuberculosis (TB) cases in HIV-infected persons. Retrospective study of all new TB/HIV cases (n=372) registered in 2013-2014 in Novokuznetsk (pop. 549 thousand). In 2014 co-infection (TB/HIV) was registered in 33,3% of all new TB cases. Mean age was 34,8±8,1years; median CD4 count was 185 cells/μl, most of the patients did not receive antiretrovirals (n=260, 69,8%). Pulmonary TB was in 97,3% of all cases (n=362); disseminated TB was the most frequent form (n=160, 44,2%). Extrapulmonary TB without lung involvement was diagnosed in 10 patients (2,7%). Smear and/or culture positive were 71,8% (n=260) of pulmonary TB cases. Drug susceptibility test (DST) was conducted on Löwenstein-Jensen media using absolute concentration method in 210 out of 232 positive cultures (90,5%). Drug susceptible TB was found in 31,9% (n=67); primary multidrug resistance (MDR) was detected in 51,4% (n=108) of patients. Patients were treated with I line drugs in the absence of resistance data or in susceptible TB. MDR TB treatment regimen was conducted in 46 patients (42,6% of all detected MDR cases), the remaining (n=62, 57,4%) were not assigned to II line drugs because of different reasons (extreme non-compliance, patient refusal or DST obtained after death). Treatment outcomes were as follows: 38,2% were classified as “cured” (n=142) and 7,8% (n=29) – as “completed anti-TB treatment”, failure was registered in 5,9% (n=22), defaults - in 2,1% (n=8), 5,1% (n=19) were transferred out and 40,9% of patients died (n=152). This study revealed treatment of TB/HIV to be successful in 46%, deaths occurred in 40,9% of patients; MDR was detected in 51,4% of cases.