Prevalence of TB/ HIV co-infection in Iran: a systematic review and meta-analysis

Abstract

Introduction: Co-infection of TB/ HIV is an emerging threat to a global public health. Although several studies have investigated the prevalence of TB/HIV co-infection in Iran, the results are inconsistent. The current systematic review and meta-analysis was planned to estimate the overall prevalence of TB/HIV co-infection in Iran.

Methods: Electronic databases, including MEDLINE (via PubMed), SCOPUS, SID and Mag Iran (two Persian scientific search engines) were searched up to 27 Apr 2017. The random effect model was used for estimating the prevalence of TB/ HIV co-infection. Heterogeneity was assessed by subgroup analysis.

Results: Forty-eight articles met our inclusion criteria, with a total of 21,388 individuals. The meta-analysis demonstrates that the prevalence of TB/ HIV co-infection in Iran was 14% [95% confidence interval CI:12-15%]. According to the meta-analysis of 5 subgroups, the prevalence of TB/ HIV co-infection in the subgroup with high intravenous drug users (IVDU) [27%, 95% CI: 20-35%], in border provinces of Iran [17%, 95% CI: 13-21%], in the subgroup with pulmonary tuberculosis (PTB) ≥ 20% [22%, 95% CI: 17-27%], in patients <40 years of age [25%, 95 CI: 19-31%] was significantly higher. There were no significant differences between the prevalence of co-infection among low and high-quality studies. Pulmonary TB was the predominant type of TB among co-infected patients [77%, 95% CI: 71 to 84%].

Conclusions: Our study demonstrates that the overall prevalence of TB/HIV co-infection in Iran was 14% [95% CI: 12-15%], which was a high rate. Some factors such as using intravenous drugs, living in border provinces of Iran, having PTB, and age <40 years had an impact on the prevalence of co-infection. Results revealed the need of HIV surveillance program among TB patients and screening of HIV-positive patients for diagnosis and treatment of TB. Further large-scale studies about the prevalence of this infection in all provinces of Iran are needed.

Keywords: Iran; Prevalence; TB/HIV co-infection.