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Meta-Analysis
. 2014 Nov 12;9(11):e112017.
doi: 10.1371/journal.pone.0112017. eCollection 2014.

The impact of antiretroviral therapy on mortality in HIV positive people during tuberculosis treatment: a systematic review and meta-analysis

Anna Odone  1 , Silvia Amadasi  2 , Richard G White  3 , Theodore Cohen  4 , Alison D Grant  5 , Rein M G J Houben  3
Affiliations
Meta-Analysis

The impact of antiretroviral therapy on mortality in HIV positive people during tuberculosis treatment: a systematic review and meta-analysis

Anna Odone et al. PLoS One. .

Abstract

Objective: To quantify the impact of antiretroviral therapy (ART) on mortality in HIV-positive people during tuberculosis (TB) treatment.

Design: We conducted a systematic literature review and meta-analysis. Studies published from 1996 through February 15, 2013, were identified by searching electronic resources (Pubmed and Embase) and conference books, manual searches of references, and expert consultation. Pooled estimates for the outcome of interest were acquired using random effects meta-analysis.

Subjects: The study population included individuals receiving ART before or during TB treatment.

Main outcome measures: Main outcome measures were: (i) TB-case fatality ratio (CFR), defined as the proportion of individuals dying during TB treatment and, if mortality in HIV-positive people not on ART was also reported, (ii) the relative risk of death during TB treatment by ART status.

Results: Twenty-one studies were included in the systematic review. Random effects pooled meta-analysis estimated the CFR between 8% and 14% (pooled estimate 11%). Among HIV-positive TB cases, those receiving ART had a reduction in mortality during TB treatment of between 44% and 71% (RR = 0.42, 95%CI: 0.29-0.56).

Conclusion: Starting ART before or during TB therapy reduces the risk of death during TB treatment by around three-fifths in clinical settings. National programmes should continue to expand coverage of ART for HIV positive in order to control the dual epidemic.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1. PRISMA flow diagram of papers selected.
Figure 2
Figure 2. Forest plot of 16 studies reporting TB-CFR for HIV positive patients receiving ART (by Region).
Figure 3
Figure 3. Forest plot studies reporting the relative risk of death during TB treatment by ART status.
See this image and copyright information in PMC

References

    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: 1009–1021. - PubMed
    1. WHO (2013) Global Tuberculosis Report 2013. Geneva: World Health Organisation.
    1. Suthar AB, Lawn SD, del Amo J, Getahun H, Dye C, et al. (2012) Antiretroviral therapy for prevention of tuberculosis in adults with HIV: a systematic review and meta-analysis. PLoS Med 9: e1001270. - PMC - PubMed
    1. Curran A, Falco V, Pahissa A, Ribera E (2012) Management of tuberculosis in HIV-infected patients. AIDS Rev 14: 231–246. - PubMed
    1. Abdool Karim SS, Naidoo K, Grobler A, Padayatchi N, Baxter C, et al. (2010) Timing of initiation of antiretroviral drugs during tuberculosis therapy. New England Journal of Medicine 362: 697–706. - PMC - PubMed

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