3 research outputs found
Mycobacterium tuberculosis Drug Resistance, Abkhazia
To the Editor: Drug-resistant
tuberculosis (TB) has been identified
as a major problem in the former
Soviet Union, and was recently surveyed
in the Aral Sea regions of
Dashoguz (Turkmenistan) and
Karakalpakstan (Uzbekistan) (1).
However, few data are available for
the Caucasian region and published
reports have focused mainly on prisons
(2,3).
We report a drug resistance survey
for first- and second-line anti-TB
drugs conducted in Abkhazia, a
Caucasian region of 8,600 km2 with
approximately 250,000 inhabitants, at
the western end of Georgia on the
Black Sea
Safety of Treatment Regimens Containing Bedaquiline and Delamanid in the endTB Cohort.
BACKGROUND: Safety of treatment for multidrug-resistant tuberculosis (MDR/RR-TB) can be an obstacle to treatment completion. Evaluate safety of longer MDR/RR-TB regimens containing bedaquiline and/or delamanid. METHODS: Multicentre (16 countries), prospective, observational study reporting incidence and frequency of clinically relevant adverse events of special interest (AESIs) among patients who received MDR/RR-TB treatment containing bedaquiline and/or delamanid. The AESIs were defined a priori as important events caused by bedaquiline, delamanid, linezolid, injectables, and other commonly used drugs. Occurrence of these events was also reported by exposure to the likely causative agent. RESULTS: Among 2296 patients, the most common clinically relevant AESIs were peripheral neuropathy (26.4%), electrolyte depletion (26.0%), and hearing loss (13.2%) with an incidence per 1000 person months of treatment, 1000 person-months of treatment 21.5 (95% confidence interval [CI]: 19.8-23.2), 20.7 (95% CI: 19.1-22.4), and 9.7 (95% CI: 8.6-10.8), respectively. QT interval was prolonged in 2.7% or 1.8 (95% CI: 1.4-2.3)/1000 person-months of treatment. Patients receiving injectables (Nâ
=â
925) and linezolid (Nâ
=â
1826) were most likely to experience events during exposure. Hearing loss, acute renal failure, or electrolyte depletion occurred in 36.8% or 72.8 (95% CI: 66.0-80.0) times/1000 person-months of injectable drug exposure. Peripheral neuropathy, optic neuritis, and/or myelosuppression occurred in 27.8% or 22.8 (95% CI: 20.9-24.8) times/1000 patient-months of linezolid exposure. CONCLUSIONS: AEs often related to linezolid and injectable drugs were more common than those frequently attributed to bedaquiline and delamanid. MDR-TB treatment monitoring and drug durations should reflect expected safety profiles of drug combinations. CLINICAL TRIALS REGISTRATION: NCT02754765
Epidemiological characteristics and realâworld treatment outcomes of hepatitis C among HIV/HCV coâinfected patients in Myanmar: A prospective cohort study
Abstract Background and Aims In Myanmar, public sector treatment programs for hepatitis C virus (HCV) infection were nonexistent until June 2017. WHO highlights the importance of simplification of HCV service delivery through taskâshifting among health workers and decentralization to the primary health care level. Between November 2016 and November 2017, a study was conducted to describe the epidemiological data and realâworld outcomes of treating HIV/HCV coinfected patients with generic direct acting antiviral (DAA) based regimens in the three HIV clinics run by nonspecialist medical doctors in Myanmar. Methods HCV coâinfection among people living with HIV (PLHIV) from two clinics in Yangon city and one clinic in Dawei city was screened by rapid diagnostic tests and confirmed by testing for viral RNA. Nonspecialist medical doctors prescribed sofosbuvir and daclatasvir based regimens (with or without ribavirin) for 12 or 24 weeks based on the HCV genotype and liver fibrosis status. Sustained virologic response at 12 weeks after treatment (SVR12) was assessed to determine cure. Results About 6.5% (1417/21,777) of PLHIV were coâinfected with HCV. Of 864 patients enrolled in the study, 50.8% reported history of substance use, 27% history of invasive medical procedures and 25.6% history of incarceration. Data on treatment outcomes were collected from 267 patients of which 257 (96.3%) achieved SVR12, 7 (2.6%) failed treatment, 2 (0.7%) died and 1 (0.4%) became loss to followâup. Conclusion The study results support the integration of hepatitis C diagnosis and treatment with DAAâbased regimens into existing HIV clinics run by nonspecialist medical doctors in a resourceâlimited setting. Epidemiological data on HIV/HCV coâinfection call for comprehensive HCV care services among key populations like drug users and prisoners in Yangon and Dawei