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Meta-Analysis
. 2014 Jan 8;9(1):e82235.
doi: 10.1371/journal.pone.0082235. eCollection 2014.

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

Yonatan Moges Mesfin  1 , Damen Hailemariam  2 , Sibhatu Biadgilign, Kelemu Tilahun Kibret  3
Affiliations
Meta-Analysis

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

Yonatan Moges Mesfin et al. PLoS One. .

Erratum in

  • PLoS One. 2014;9(2):e89709. Biadglign, Sibhatu [corrected to Biadgilign, Sibhatu]

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
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
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
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
Figure 4. Forest Plot of the 24 observational Studies That Quantitatively Assessed the Association between HIV/AIDS and multi-drug resistance tuberculosis.
Figure 5
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.
See this image and copyright information in PMC

References

    1. Van Soolingen D (2001) Molecular epidemiology of tuberculosis and other mycobacterium infections: main methodologies and achievements. J Intern Med 249 (1) 1–26. - PubMed
    1. Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, et al. (2003) The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med 163 (9) 1009–1021. - PubMed
    1. World Health Organization (2011) Global Tuberculosis Control Epidemiology, Strategy, Financing WHO/HTM/TB Geneva 2011; 16.
    1. WHO report (2008) global tuberculosis control. Surveillance, planning, financing Rep WHO/HTM/TB/2008393geneva: world health organization 2008.
    1. WHO report (2010), Global report on surveillance and response on multidrug and extensively drug-resistant TB (M/XDR-TB) WHO/HTM/TB/3 Genev 2010.

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