The effect of tuberculosis treatment on virologic and <script type="math/tex">CD4^{+}</script> cell count response to combination antiretroviral therapy: a systematic review

Soeters, Heidi M.; Napravnik, Sonia; Patel, Monita R.; Eron, Joseph J., Jr.; Van Rie, Annelies

doi:10.1097/01.AIDS.0000434936.57880.CD

Title

The effect of tuberculosis treatment on virologic and $CD4^{+}$ cell count response to combination antiretroviral therapy: a systematic review

Author

Soeters, Heidi M.

Napravnik, Sonia

Patel, Monita R.

Eron, Joseph J., Jr.

Van Rie, Annelies

Abstract

Objective: To determine the impact of tuberculosis (TB) treatment at the time of combination antiretroviral therapy (cART) initiation on virologic and CD4(+) cell count response to cART. Methods: Systematic review and meta-analysis of studies reporting HIV RNA and CD4(+) cell count response, stratified by TB treatment status at cART initiation. Stratified random-effects and meta-regression analyses were used when possible. Results: Twenty-five eligible cohort studies reported data on 49578 (range 42-15646) adults, of whom 8826 (18%) were receiving TB treatment at cART initiation. Seventeen studies reported virologic response; 21 reported CD4(+) cell count response. The summarized random-effects relative risk (RRRE) of virologic suppression in those receiving vs. not receiving TB treatment at different time points following cART initiation was 1.06 (0.86-1.29) at 1-4 months, 0.91 (0.83-1.00) at 6 months, 0.99 (0.94-1.05) at 11-12 months, and 0.99 (0.77-1.28) at 18-48 months. The overall RRRE at 1-48 months was 0.97 (95% confidence interval 0.92-1.03). Available data regarding the effect of TB treatment on virologic failure were heterogeneous and inconclusive (13 estimates). Differences in median CD4(+) cell count gain between those receiving vs. not receiving TB treatment ranged from -10 to 60cells/l (median 27) by 6 months (seven estimates) and -10 to 29 (median 6) by 11-12 months (five estimates), although the heterogeneity of the response measures did not support meta-analysis. Conclusion: Patients receiving TB treatment at cART initiation experience similar virologic suppression and CD4(+) cell count reconstitution as those not receiving TB treatment, reinforcing the need to start cART during TB treatment and allowing more confidence in clinical decision-making. (c) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Language

English

Source (journal)

AIDS. - London

Publication

London : 2014

ISSN

0269-9370

DOI

10.1097/01.AIDS.0000434936.57880.CD

Volume/pages

28 :2 (2014) , p. 245-255