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HIV Infection and Drug-resistant TB in Ukraine: A Threatening Convergence of 2 Epidemics?
I Dubrovina1, K Miskinis2, S Lyepshina3, Y Yann4, H Hoffmann5, R Zaleskis6, P Nunn7, and Matteo Zignol*7
1WHO, Project Office, Donetsk, Ukraine; 2WHO, Country Office, Kiev, Ukraine; 3Donetsk State Med Univ, Ukraine; 4Donetsk TB Reference Lab, Ukraine; 5Inst of Microbio and Lab Med, Asklepios Fachkliniken München-Gauting, Germany; 6WHO, European Regional Office, Copenhagen, Denmark; and 7WHO Headquarters, Geneva, Switzerland
Background: Ukraine is second only to the Russian
Federation among countries of the Former Soviet Union in the size of the epidemics
of HIV and TB. Although no reliable and representative data of the extent of
anti-TB drug resistance are available in the country the possible overlap of
the epidemics of HIV and multidrug-resistant TB (MDR-TB) represents a major public
health concern. This study aims to investigate the association between HIV
infection and MDR-TB in the civilian and penitentiary sectors of Donetsk
Oblast, the largest Oblast of Ukraine, home of nearly 10% of the country
population.
Methods: From July 1 2005 to June 30 2006 all
consecutive newly diagnosed and previously treated cases with sputum
smear-positive TB presenting to all TB units in Donetsk Oblast were invited to
take part in the study. A total of 1289 and 204 patients with TB were tested
for HIV and MDR-TB in the civilian and penitentiary sectors, respectively. The
following information was collected for each patient: sex, age, place of
residence, and history of TB treatment.
Results: Overall, HIV+ cases were
significantly more likely to have MDR-TB compared to HIV– cases (RR
1.3, 95%CI 1.1 to 1.5). In the multivariate analysis HIV status was found
significantly associated with MDR-TB (OR 1.7, 95%CI 1.3 to 2.3). History of
previous treatment (OR 4.0, 95%CI 3.1 to 5.1) and imprisonment (OR 1.5, 95%CI
1.1 to 2.0) were also found independent predictors for MDR-TB. In the civilian
sector MDR-TB rates were 21.6% (95%CI 19.0 to 24.3) and 28.0% (95%CI 22.8 to 33.8)
among cases with negative and positive HIV status, respectively. In the prison
sector MDR-TB rates were 37.0% (95%CI 29.6 to 44.8) and 58.3% (95%CI 40.8 to 74.5)
in patients with negative and positive HIV status, respectively.
Conclusions: A positive association between HIV and
MDR-TB epidemics is found in Donetsk Oblast, Ukraine. The overlapping of the
HIV and MDR-TB epidemics is likely to result in more complex patients'
management, poorer treatment outcomes, and greater disease transmission. The
findings of this study call for urgent measures to improve HIV prevention,
control of drug-resistant TB, collaboration between HIV and TB control
activities, and infection control in congregate settings.
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