Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis
OBJECTIVE: To systematically assess treatment outcomes among HIV–MDR-TB co-infected patients.
METHODS: We searched two 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.
Keywords: human immunodeficiency virus/AIDS; meta-analysis; mortality; multidrug-resistant tuberculosis; treatment success
Document Type: Research Article
Affiliations: 1: *Médecins Sans Frontières, Mumbai, India;, †Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece 2: †Operational Center Amsterdam, Médecins Sans Frontières, Amsterdam, The Netherlands 3: *Médecins Sans Frontières, Mumbai, India; 4: †Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece 5: §Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
Publication date: 01 August 2015
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