Association between HIV/AIDS and multi-drug resistance tuberculosis: a systematic review and meta-analysis

Abstract

Background: Human immunodeficiency virus (HIV), multi-drug resistant tuberculosis (MDR) is emerging as major challenge facing tuberculosis control programs worldwide particularly in Asia and Africa. Findings from different studies on associations of HIV co-infection and drug resistance among patients with TB have been contradictory (discordant). Some institution based studies found strongly increased risks for multi-drug resistant TB (MDR TB) among patients co-infected with TB and HIV, whereas other studies found no increased risk (it remains less clear in community based studies. The aim was to conduct a systematic review and meta-analysis of the association between multi-drug resistant tuberculosis and HIV infection.

Methods and findings: Systematic review of the published literature of observational studies was conducted. Original studies were identified using databases of Medline/Pubmed, Google Scholar and HINARI. The descriptions of original studies were made using frequency and forest plot. Publication bias was assessed using Funnel plot graphically and Egger weighted and Begg rank regression tests statistically. Heterogeneity across studies was checked using Cochrane Q test statistic and I(2). Pool risk estimates of MDR-TB and sub-grouping analysis were computed to analyze associations with HIV. Random effects of the meta-analysis of all 24 observational studies showed that HIV is associated with a marginal increased risk of multi-drug resistant tuberculosis (estimated Pooled OR 1.24; 95%, 1.04-1.43). Subgroup analyses showed that effect estimates were higher (Pooled OR 2.28; 95%, 1.52-3.04) for primary multi-drug resistance tuberculosis and moderate association between HIV/AIDS and MDR-TB among population based studies and no significant association in institution settings.

Conclusions: This study demonstrated that there is association between MDR-TB and HIV. Capacity for diagnosis of MDR-TB and initiating and scale up of antiretroviral treatment, and collaborations between HIV and TB control programs need to be considered and strengthened.

Figure 1. Flow chart diagram describing selection of studies for a systematic review (identification, screening, eligible and included studies).

Articles may have been excluded for more than one reason.

Figure 2. Funnel plot of with 95% confidence limit; the horizontal line in the funnel plot indicates the effect estimate, while the sloping lines indicate the expected 95% confidence intervals.

Figure 3. Cumulative forest plot.

The first row shows the effect based on one study, the second row shows the cumulative effect based on two studies, and so on.

Figure 4. Forest Plot of the 24 observational Studies That Quantitatively Assessed the Association between HIV/AIDS and multi-drug resistance tuberculosis.

Figure 5. Forest Plot of the 24 Studies That Quantitatively Assessed the Association between HIV/AIDS and multi-drug resistance tuberculosis by MDR-TB type.