RT Journal Article
SR Electronic
T1 Treatment outcomes and deaths among multidrug-resistant tuberculosis (MDR-TB) patients in Gomel region, Belarus - 2009-2010
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 191
VO 42
IS Suppl 57
A1 Alena Skrahina
A1 Andrei Khaliaukin
A1 Dennis Falzon
A1 Valiantsin Rusovich
A1 Masoud Dara
A1 Aliaksandr Shyrayeu
A1 Liudmila Zhylevich
A1 Matteo Zignol
A1 Hennadz Hurevich
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/191.abstract
AB Background: In Gomel, a region in south-east Belarus (country population 9.5 million in 2011; Gomel 1.5 million), TB patients with strains resistant to at least isoniazid and rifampicin (multidrug-resistance;MDR-TB) have been treated using standardised regiments with second-line drugs since 2009.Methods: We analyse factors associated with death in MDR-TB patients started on treatment in 2009-2010.Results: Of 514 confirmed MDR-TB patients, 436 (85%) started treatment. Median age was 45y (IQR:36-52), 84% were males, 15% were HIV-infected (40% on antiretrovirals) and 6% had additional resistance to ofloxacin plus a second-line injectable (XDR). 34% of patients were successfully treated, in 13% treatment failed, 35% died, and 18% interrupted therapy. Among the 152 deaths, 64% were attributed to pulmonary TB, 25% to HIV/AIDS, 6% to associated malignancy, and 5% to other causes. At multivariable regression, death was statistically-significantly associated with age>34 y (adjusted odds ratios: 2.2; 95% confidence limits:1.2-4.2), previous treatment with second-line drugs (2.5;1.3-5.0), HIV-infection (2.9;1.5-5.8); and protective effects were associated with ethambutol (0.5;0.3-0.9), ofloxacin (0.2;0.1-0.4) and prothionamide/ethionamide (0.4;0.2-0.6).Conclusion: In these first MDR-TB patients placed on standardised treatment, regimens were not optimised with negligible access to later-generation fluoroquinolones. Many patients had long-standing disease and more extensive lesions. No social support was provided to MDR-TB patients before 2011. With enhanced regimens, expanded access to antiretrovirals and social support, treatment outcomes are expected to improve.