Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Sep 24;29(15):1987-2002.
doi: 10.1097/QAD.0000000000000802.

Prevalence of tuberculosis in post-mortem studies of HIV-infected adults and children in resource-limited settings: a systematic review and meta-analysis

Rishi K Gupta  1 , Sebastian B Lucas, Katherine L Fielding, Stephen D Lawn
Affiliations
Meta-Analysis

Prevalence of tuberculosis in post-mortem studies of HIV-infected adults and children in resource-limited settings: a systematic review and meta-analysis

Rishi K Gupta et al. AIDS. .

Abstract

Objectives: Tuberculosis (TB) is estimated to be the leading cause of HIV-related deaths globally. However, since HIV-associated TB frequently remains unascertained, we systematically reviewed autopsy studies to determine the true burden of TB at death.

Methods: We systematically searched Medline and Embase databases (to end 2013) for literature reporting on health facility-based autopsy studies of HIV-infected adults and/or children in resource-limited settings. Using forest plots and random-effects meta-analysis, we summarized the TB prevalence found at autopsy and used meta-regression to explore variables associated with autopsy TB prevalence.

Results: We included 36 eligible studies, reporting on 3237 autopsies. Autopsy TB prevalence was extremely heterogeneous (range 0-64.4%), but was markedly higher in adults [pooled prevalence 39.7%, 95% confidence interval (CI) 32.4-47.0%] compared to children (pooled prevalence 4.5%, 95% CI 1.7-7.4%). Post-mortem TB prevalence varied by world region, with pooled estimates in adults of 63.2% (95% CI 57.7-68.7%) in South Asia (n = 2 studies); 43.2% (95% CI 38.0-48.3) in sub-Saharan Africa (n = 9 studies); and 27.1% (95% CI 16.0-38.1%) in the Americas (n = 5 studies). Autopsy prevalence positively correlated with contemporary estimates of national TB prevalence. TB in adults was disseminated in 87.9% (82.2-93.7%) of cases and was considered the cause of death in 91.4% (95% CI 85.8-97.0%) of TB cases. Overall, TB was the cause of death in 37.2% (95% CI 25.7-48.7%) of adult HIV/AIDS-related deaths. TB remained undiagnosed at death in 45.8% (95% CI 32.6-59.1%) of TB cases.

Conclusions: In resource-limited settings, TB accounts for approximately 40% of facility-based HIV/AIDS-related adult deaths. Almost half of this disease remains undiagnosed at the time of death. These findings highlight the critical need to improve the prevention, diagnosis and treatment of HIV-associated TB globally.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow diagram showing study selection process and reasons for exclusions.
Fig. 2 (Continued)
Fig. 2 (Continued)
Forest plots showing post-mortem prevalence [% (95% CI)] of tuberculosis (TB) in the following as given in the legend.
Fig. 2 (Continued)
Fig. 2 (Continued)
Forest plots showing post-mortem prevalence [% (95% CI)] of tuberculosis (TB) in the following as given in the legend.
Fig. 2 (Continued)
Fig. 2 (Continued)
Forest plots showing post-mortem prevalence [% (95% CI)] of tuberculosis (TB) in the following as given in the legend.
Fig. 3
Fig. 3
Meta-regression analyses showing graphs of post-mortem prevalence of tuberculosis (Y-axis) plotted against the following.
See this image and copyright information in PMC

References

    1. World Health Organization. World Health Organization Global TB Report 2014. Geneva, Switzerland. http://www.who.int/tb/publications/global_report/en/ [Accessed 28 January 2015]
    1. UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2013. 2013. http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Global_Repo... [Accessed 28 January 2015]
    1. World Health Organization. WHO policy on collaborative TB/HIV activities: guidelines for national programmes and other stakeholders. Geneva, Switzerland. 2012. http://www.who.int/tb/publications/2012/tb_hiv_policy_9789241503006/en/ [Accessed 28 January 2015] - PubMed
    1. Mudenda V, Lucas S, Shibemba A, O’Grady J, Bates M, Kapata N, et al. Tuberculosis and tuberculosis/HIV/AIDS-associated mortality in Africa: the urgent need to expand and invest in routine and research autopsies. J Infect Dis 2012; 205 Suppl:S340–S346. - PubMed
    1. Lucas S. Causes of death in the HAART era. Curr Opin Infect Dis 2012; 25:36–41. - PubMed

Publication types