Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America

Objectives

Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA).

Design and Methods

Between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled.

Results

Significant differences were observed between EE (N = 844), WE (N = 152), SE (N = 164), and LA (N = 253) in the proportion of patients with a definite TB diagnosis (47%, 71%, 72% and 40%, p<0.0001), MDR-TB (40%, 5%, 3% and 15%, p<0.0001), and use of combination antiretroviral therapy (cART) (17%, 40%, 44% and 35%, p<0.0001). Injecting drug use (adjusted OR (aOR) = 2.03 (95% CI 1.00–4.09), prior anti-TB treatment (3.42 (1.88–6.22)), and living in EE (7.19 (3.28–15.78)) were associated with MDR-TB. Among 585 patients with drug susceptibility test (DST) results, the empiric (i.e. without knowledge of the DST results) anti-TB treatment included ≥3 active drugs in 66% of participants in EE compared with 90–96% in other regions (p<0.0001).

Conclusions

In EE, TB/HIV patients were less likely to receive a definite TB diagnosis, more likely to house MDR-TB and commonly received empiric anti-TB treatment with reduced activity. Improved management of TB/HIV patients in EE requires better access to TB diagnostics including DSTs, empiric anti-TB therapy directed at both susceptible and MDR-TB, and more widespread use of cART.     

THE USE OF ENDRIN AND OTHER INSECTICIDES AGAINST LETTUCE ROOT APHID, PEMPHIGUS BURSARIUS L

Several insecticides have been used as protectants against lettuce root aphid, including, in 1955, lindane, schradan, aldrin and endrin; the last-named giving the most promising results. With a dressing of an equal weight of 50% endrin dust added to lettuce seed, 86% reduction in aphid numbers was obtained. In 1957, a seed dressing with endrin also gave a good control, which was superior to that obtained with thimet 44D. However, in 1956 and 1958 endrin seed dressing failed to control the aphid. When a seed dressing with endrin was supplemented by an endrin spray applied to the seedlings a consistently good control resulted.
A high level of aphid control was obtained in 1958 with two sprays of diazinon applied along the lettuce rows, the first applied after singling and the other at the early rosette stage. Diazinon or endrin, applied to the soil at 4 lb. actual insecticide/acre and rotavated into the top 3 in. before sowing, also gave high levels of control.
No recommendations for the use of endrin on lettuce can be made until levels and persistence of residues are known.