Publication
Title
The effect of tuberculosis treatment at combination antiretroviral therapy initiation on subsequent mortality : a systematic review and meta-analysis
Author
Abstract
Objective: We aimed to perform a systematic review and meta-analysis examining the impact of TB treatment at the time of combination antiretroviral therapy (cART) initiation on subsequent mortality. Methods: We searched PubMed, EMBASE, and selected conference proceedings for studies that report adult mortality on cART, stratified by TB treatment status at cART initiation. Stratified random-effects and meta-regression analyses were used to examine the influence of study and population characteristics. Results: 22 eligible cohort studies reported data on 98,350 (range 74-15,225) adults, of whom 14,779 (15%) were receiving TB treatment at cART initiation. Studies of those receiving vs. not receiving TB treatment had an average mortality relative risk of 1.10 (95% confidence interval 0.87-1.40) at 1-3 months (based upon 8 estimates), 1.15 (0.94-1.41) at 6-12 months (11 estimates), and 1.33 (1.02-1.75) at 18-98 months (10 estimates) following cART initiation. However, there was a wide range of estimates and those at later time points were markedly heterogeneous. Meta-regression identified factors associated with elevated average risk estimates: lower median baseline CD4 counts and adjustment for baseline hemoglobin at 1-3 months; longer length of follow-up and women-only studies at 6-12 months; and not adjusting for BMI/weight at 18-98 months. Conclusions: Patients receiving TB treatment at cART initiation did not have a statistically significant estimated increase in short-term risk of all-cause mortality as compared to those not receiving TB treatment. TB treatment was significantly associated with increased mortality after about a year of cART, suggesting that patients with concurrent TB treatment at cART initiation may benefit from continued support after TB treatment completion.
Language
English
Source (journal)
PLoS ONE
Publication
San francisco : Public library science , 2013
ISSN
1932-6203
DOI
10.1371/JOURNAL.PONE.0078073
Volume/pages
8 :10 (2013) , 9 p.
Article Reference
UNSP e78073
ISI
000325894100099
Medium
E-only publicatie
Full text (Publisher's DOI)
Full text (open access)
UAntwerpen
Publication type
Subject
External links
Web of Science
Record
Identifier
Creation 15.02.2018
Last edited 31.01.2023
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