Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis
This study aims to assess treatment outcomes among HIV–MultiDrug-Resistant -TB co-infected patients
Abstract
Background
The incidence of multidrug-resistant tuberculosis (MDR-TB) is increasing in high human immunodeficiency virus (HIV) prevalence settings, with high associated mortality. Treatment outcomes in HIV-co-infected adults and children are poorly documented.
Objective
To systematically assess treatment outcomes among HIV–MDR-TB co-infected patients.
Methods
We searched 2 databases and the proceedings of an annual international conference up to November 2014 for studies reporting on major clinical outcomes among HIV–MDR-TB-co-infected adults and children, and pooled the results using random-effects meta-analysis.
Results
Of 4812 abstracts and articles screened, 30 studies providing data on 2578 adults and 147 children were included. Overall pooled treatment success was 56.9% (95% confidence interval [CI] 46.2–67.6), 49.9% (95%CI 38.5–61.2) among adults and 83.4% (95%CI 74.7–92) among children. Mortality was 38% in adults (95%CI 28–48.1) and 11.4% (95%CI 5.8–17.1) in children. Loss to follow-up was higher among adults (16.1%, 95%CI 9–23.2) than among children (3.9%, 95%CI 0.9–6.9). Adverse events were experienced by the majority of patients; however, this was inconsistently documented. The use of fluoroquinolones, aminoglycosides and Group IV drugs appeared to be associated with treatment success.
Conclusion
The proportion of HIV–MDR-TB-co-infected patients achieving treatment success was similar to success rates reported among MDR-TB patients in general, regardless of HIV status; however, mortality was higher, particularly among adults, highlighting the need for early diagnosis and more effective treatment regimens.
This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)
Citation
Isaakidis P, Casas EC, Das M, Tseretopoulou X, Ntzani EE, Ford N (2015) Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis. Inernational Journal for Tuberculosis and Lung Disease. 2015 Aug;19(8):969-78. doi: 10.5588/ijtld.15.0123