Antiretroviral therapy for prevention of tuberculosis in adults with HIV : a systematic review and Meta-Analysis
Date
2012-07
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science
Abstract
Background: Human immunodeficiency virus (HIV) infection is the strongest risk factor for developing tuberculosis and has
fuelled its resurgence, especially in sub-Saharan Africa. In 2010, there were an estimated 1.1 million incident cases of
tuberculosis among the 34 million people living with HIV worldwide. Antiretroviral therapy has substantial potential to
prevent HIV-associated tuberculosis. We conducted a systematic review of studies that analysed the impact of antiretroviral
therapy on the incidence of tuberculosis in adults with HIV infection.
Methods and Findings: PubMed, Embase, African Index Medicus, LILACS, and clinical trial registries were systematically
searched. Randomised controlled trials, prospective cohort studies, and retrospective cohort studies were included if they
compared tuberculosis incidence by antiretroviral therapy status in HIV-infected adults for a median of over 6 mo in
developing countries. For the meta-analyses there were four categories based on CD4 counts at antiretroviral therapy
initiation: (1) less than 200 cells/ml, (2) 200 to 350 cells/ml, (3) greater than 350 cells/ml, and (4) any CD4 count. Eleven studies
met the inclusion criteria. Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis in all
baseline CD4 count categories: (1) less than 200 cells/ml (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.07 to 0.36), (2)
200 to 350 cells/ml (HR 0.34, 95% CI 0.19 to 0.60), (3) greater than 350 cells/ml (HR 0.43, 95% CI 0.30 to 0.63), and (4) any CD4
count (HR 0.35, 95% CI 0.28 to 0.44). There was no evidence of hazard ratio modification with respect to baseline CD4 count
category (p = 0.20).
Conclusions: Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis across all CD4
count strata. Earlier initiation of antiretroviral therapy may be a key component of global and national strategies to control
the HIV-associated tuberculosis syndemic.
Description
CITATION: Suthar, A. B. 2012. Antiretroviral therapy for prevention of tuberculosis in adults with HIV : a systematic review and Meta-Analysis. PLoS Medicine, 9(7): 1-15, doi: 10.1371/journal.pmed.1001270.
The original publication is available at http://journals.plos.org/plosmedicine
The original publication is available at http://journals.plos.org/plosmedicine
Keywords
HIV-positive persons, Human immunodeficiency virus, Tuberculosis -- Africa, Sub-Saharan, Antiretroviral agents, Meta-analyses, Baseline CD4 count
Citation
Suthar, A. B. 2012. Antiretroviral therapy for prevention of tuberculosis in adults with HIV : a systematic review and Meta-Analysis. PLoS Medicine, 9(7): 1-15, doi: 10.1371/journal.pmed.1001270