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Incidence of HIV-associated tuberculosis among individuals taking combination antiretroviral therapy: a systematic review and meta-analysis.

Kufa T, Mabuto T, Muchiri E, Charalambous S, Rosillon D, Churchyard G, Harris RC - PLoS ONE (2014)

Bottom Line: Cohorts from high/intermediate burden settings were smaller in size, had lower median CD4 cell counts at study entry and fewer person-years of follow up.Tuberculosis incidence rates decreased with increasing CD4 count at study entry and duration on combination antiretroviral therapy.Interventions to prevent tuberculosis in this population should address geographical, socioeconomic and individual factors such as low CD4 counts and prior history of tuberculosis.

View Article: PubMed Central - PubMed

Affiliation: The Aurum Institute, Johannesburg, South Africa; The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.

ABSTRACT

Background: Knowledge of tuberculosis incidence and associated factors is required for the development and evaluation of strategies to reduce the burden of HIV-associated tuberculosis.

Methods: Systematic literature review and meta-analysis of tuberculosis incidence rates among HIV-infected individuals taking combination antiretroviral therapy.

Results: From PubMed, EMBASE and Global Index Medicus databases, 42 papers describing 43 cohorts (32 from high/intermediate and 11 from low tuberculosis burden settings) were included in the qualitative review and 33 in the quantitative review. Cohorts from high/intermediate burden settings were smaller in size, had lower median CD4 cell counts at study entry and fewer person-years of follow up. Tuberculosis incidence rates were higher in studies from Sub-Saharan Africa and from World Bank low/middle income countries. Tuberculosis incidence rates decreased with increasing CD4 count at study entry and duration on combination antiretroviral therapy. Summary estimates of tuberculosis incidence among individuals on combination antiretroviral therapy were higher for cohorts from high/intermediate burden settings compared to those from the low tuberculosis burden settings (4.17 per 100 person-years [95% Confidence Interval (CI) 3.39-5.14 per 100 person-years] vs. 0.4 per 100 person-years [95% CI 0.23-0.69 per 100 person-years]) with significant heterogeneity observed between the studies.

Conclusions: Tuberculosis incidence rates were high among individuals on combination antiretroviral therapy in high/intermediate burden settings. Interventions to prevent tuberculosis in this population should address geographical, socioeconomic and individual factors such as low CD4 counts and prior history of tuberculosis.

No MeSH data available.


Related in: MedlinePlus

Forest plot showing summary estimates of TB incidence rates among individuals on cART comparing cohorts from high TB burden settings to low TB burden settings.
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pone-0111209-g002: Forest plot showing summary estimates of TB incidence rates among individuals on cART comparing cohorts from high TB burden settings to low TB burden settings.

Mentions: Thirty-three cohorts were eligible for inclusion in the meta-analysis. (See Figure 2). Heterogeneity was computed separately for high/intermediate (I2 = 98%, p-value <0.001) and low (I2 = 99.1%, p-value <0.001) burden settings and was large in both settings. As expected, the summary estimate of TB incidence among those on cART was higher for cohorts from high/intermediate burden settings compared to those from the low burden settings–4.17 per 100 person-years (95% CI 3.39–5.14 per 100 person-years) vs. 0.4 per 100 person-years (95% CI 0.23–0.69 per 100 person-years, (Figure 2). In the analyses stratifying summary estimates of TB incidence rates by study quality, study design (retrospective or prospective studies), national TB incidence rates and national HIV prevalence rates (see Table 4), heterogeneity remained high. This implied that these variables did not explain most of the heterogeneity observed in the TB incidence rates.


Incidence of HIV-associated tuberculosis among individuals taking combination antiretroviral therapy: a systematic review and meta-analysis.

Kufa T, Mabuto T, Muchiri E, Charalambous S, Rosillon D, Churchyard G, Harris RC - PLoS ONE (2014)

Forest plot showing summary estimates of TB incidence rates among individuals on cART comparing cohorts from high TB burden settings to low TB burden settings.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230893&req=5

pone-0111209-g002: Forest plot showing summary estimates of TB incidence rates among individuals on cART comparing cohorts from high TB burden settings to low TB burden settings.
Mentions: Thirty-three cohorts were eligible for inclusion in the meta-analysis. (See Figure 2). Heterogeneity was computed separately for high/intermediate (I2 = 98%, p-value <0.001) and low (I2 = 99.1%, p-value <0.001) burden settings and was large in both settings. As expected, the summary estimate of TB incidence among those on cART was higher for cohorts from high/intermediate burden settings compared to those from the low burden settings–4.17 per 100 person-years (95% CI 3.39–5.14 per 100 person-years) vs. 0.4 per 100 person-years (95% CI 0.23–0.69 per 100 person-years, (Figure 2). In the analyses stratifying summary estimates of TB incidence rates by study quality, study design (retrospective or prospective studies), national TB incidence rates and national HIV prevalence rates (see Table 4), heterogeneity remained high. This implied that these variables did not explain most of the heterogeneity observed in the TB incidence rates.

Bottom Line: Cohorts from high/intermediate burden settings were smaller in size, had lower median CD4 cell counts at study entry and fewer person-years of follow up.Tuberculosis incidence rates decreased with increasing CD4 count at study entry and duration on combination antiretroviral therapy.Interventions to prevent tuberculosis in this population should address geographical, socioeconomic and individual factors such as low CD4 counts and prior history of tuberculosis.

View Article: PubMed Central - PubMed

Affiliation: The Aurum Institute, Johannesburg, South Africa; The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.

ABSTRACT

Background: Knowledge of tuberculosis incidence and associated factors is required for the development and evaluation of strategies to reduce the burden of HIV-associated tuberculosis.

Methods: Systematic literature review and meta-analysis of tuberculosis incidence rates among HIV-infected individuals taking combination antiretroviral therapy.

Results: From PubMed, EMBASE and Global Index Medicus databases, 42 papers describing 43 cohorts (32 from high/intermediate and 11 from low tuberculosis burden settings) were included in the qualitative review and 33 in the quantitative review. Cohorts from high/intermediate burden settings were smaller in size, had lower median CD4 cell counts at study entry and fewer person-years of follow up. Tuberculosis incidence rates were higher in studies from Sub-Saharan Africa and from World Bank low/middle income countries. Tuberculosis incidence rates decreased with increasing CD4 count at study entry and duration on combination antiretroviral therapy. Summary estimates of tuberculosis incidence among individuals on combination antiretroviral therapy were higher for cohorts from high/intermediate burden settings compared to those from the low tuberculosis burden settings (4.17 per 100 person-years [95% Confidence Interval (CI) 3.39-5.14 per 100 person-years] vs. 0.4 per 100 person-years [95% CI 0.23-0.69 per 100 person-years]) with significant heterogeneity observed between the studies.

Conclusions: Tuberculosis incidence rates were high among individuals on combination antiretroviral therapy in high/intermediate burden settings. Interventions to prevent tuberculosis in this population should address geographical, socioeconomic and individual factors such as low CD4 counts and prior history of tuberculosis.

No MeSH data available.


Related in: MedlinePlus