Premium
Increasing incidence of HIV‐ associated tuberculosis in Romanian injecting drug users
Author(s) -
Oprea C,
Ianache I,
Calistru PI,
Nica M,
Ruta S,
Smith C,
Lipman M
Publication year - 2018
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12576
Subject(s) - medicine , tuberculosis , drug resistance , incidence (geometry) , coinfection , human immunodeficiency virus (hiv) , population , mycobacterium tuberculosis , cohort , multi drug resistant tuberculosis , extensively drug resistant tuberculosis , pediatrics , virology , environmental health , pathology , physics , microbiology and biotechnology , optics , biology
Background A high prevalence of tuberculosis ( TB ) among HIV ‐positive injecting drug users ( IDU s) may fuel the TB epidemic in the general population of Romania. We determined the frequency and characteristics of TB in HIV ‐infected IDU s referred to a national centre. Methods Prospective observational cohort study of all newly‐diagnosed HIV ‐positive IDU s admitted to Victor Babes Hospital, Bucharest, between January 2009 and December 2014. Socio‐demographics, clinical characteristics and outcomes of HIV / TB co‐infected IDU s were compared to HIV ‐positive IDU s without TB . Results 170/598 (28.5%) HIV ‐infected IDU s were diagnosed with TB . The prevalence increased from 12.5% in 2009 to 32.1% in 2014 ( P < 0.001). HIV / TB co‐infected individuals had lower median CD 4 cell counts 75 ( vs . 450/mm 3 , P < 0.0001) and higher median HIV viral loads 5.6 log 10 ( vs . 4.9 log 10 , P < 0.0001) when presenting to healthcare services. 103/170 (60.6%) HIV / TB co‐infected IDU s were diagnosed with pulmonary TB . Resistant Mycobacterium tuberculosis strains were common, with 18/105 (17.1%) of patients having Multi‐Drug Resistant ( MDR ) disease. Higher mortality rate was associated with TB co‐infection ( P < 0.0001), extra‐pulmonary TB ( P = 0.0026) and extensively drug resistant TB ( P = 0.024). Conclusions Tuberculosis ( TB ) is an increasing problem in HIV ‐infected IDU s in Romania. Presentation is often with advanced HIV , significant TB drug resistance and consequent outcomes are poor.