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The New Profile of Drug-Resistant Tuberculosis in Russia A Global and Local Perspective: Summary of a Joint Workshop by the Institute of Medicine and the Russian Academy of Medical Science (2011) / Chapter Skim
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6 Treatment of Drug-Resistant TB
Pages 63-74

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From page 63...
... • dherence is the key to treatment success for both TB and HIV. A • he combination of aggressive drug treatment and surgery, which T is widely used in Russia, can improve the outcomes of patients with MDR TB.
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From page 64...
... Thus, as many workshop participants noted, MDR TB treatment must be provided with what is available today, tailored to the drug susceptibility patterns of patients. Speakers addressed several topics related to treatment of drug-resistant TB: the need for tailored treatment regimens based on drug susceptibility testing, treatment of drug-resistant TB in the Russian Federation, treatment of patients coinfected with TB and HIV, and innovative research in MDR TB treatment.
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From page 65...
... Of the total group, 1,278 patients had confirmed MDR TB, with corresponding clinical data. Confirmation of results of local drug susceptibility testing as MDR TB at CDC's laboratories was 96−100 percent for five countries and 84–90 percent for three countries.
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From page 66...
... Six percent of patients had XDR TB at the start of treatment. Again, the range of resistance across sites was broad, indicating that the treatment of MDR TB should be tailored to the unique epidemiology of specific populations and ideally individualized to patients' susceptibility patterns.
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From page 67...
... MDR and XDR TB accounted for 40.6 and 2.2 percent, respectively, of cases at CTRI in 2008. Among previously treated patients at CTRI, 61.6 percent had MDR TB and 16.5 percent XDR TB.
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From page 68...
... Vasilyeva concluded that the success of MDR TB treatment depends on the point at which MDR or XDR TB is detected, adequate long-term treatment regimens, the quality of second-line drugs, the use of surgical methods, and the early management of adverse drug effects. DRUG-RESISTANT TB AND COINFECTION WITH HIV3 HIV is a driving force of today's TB epidemic, said Shin.
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From page 69...
... For example, international guidelines call for ART to be given to patients with extrapulmonary TB, but there is no universal definition of extrapulmonary TB. At the same time, patients are supposed to be given numerous antiretroviral and anti-TB drugs, but Frolova expressed concern that many suffer from severe liver disorders that interfere with drug treatment.
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From page 70...
... 70 DRUG-RESISTANT TUBERCULOSIS IN RUSSIA 10,000 7 9,253 9,000 New Cases per 100,000 Population 6.5 6 Absolute Number of New Cases 7,387 8,000 5.2 5 7,000 5,985 6,000 4.2 4 5,000 3,907 3 4,000 2.7 2,926 3,000 2.1 2 2,000 1,407 833 990 1.0 1 576 1,000 0.7 271 310 0.6 0.4 0.2 0.2 0 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year Absolute no. patients Cases per 100,000 population FIGURE 6-1 The number of new cases of TB-HIV coinfection in the Russian Fed eration has grown dramaticallyFigure 6-1.eps since 1999.
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From page 71...
... Immunological and Stem Cell Therapy in MDR TB Patients4 The advent of TDR TB demands new approaches to the treatment of TB, said Maeurer. He described several recent research advances that have brought the field closer to such treatments.
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From page 72...
... It also is a way to identify drug treatment targets in patients who have XDR TB versus normal TB, which aids in clinical treatment and development and the measurement of success and failure. Maeurer and his colleagues have also used IL-7 to treat patients with XDR TB.
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From page 73...
... Thus, said Gergert, the transplant of bone marrow cells into infected mice significantly improved their survival rate with no other intervention. The life spans of these mice were comparable with those of the groups of animals that received chemotherapy or chemotherapy plus bone marrow cell transplants.
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Key Terms

  • marrow cells
  • drug susceptibility
  • russian federation
  • hiv infection
  • coinfected patients

  • treatment regimens
  • russian academy
  • drug resistance
  • medical sciences
  • susceptibility testing

  • innovative research
  • drug treatment
  • treating mdr
  • clinical trials
  • patients coinfected

  • stem cell
  • plus bone
  • cell therapy
  • marrow cell
  • treating patients

  • tailored treatment
  • controlled clinical
  • survival rate
  • directly observed
  • observed therapy

  • clinical care
  • cell transplants
  • social mutations
  • previously treated
  • susceptibility patterns


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