Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis

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. To systematically assess treatment outcomes among...

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Vydáno v:The international journal of tuberculosis and lung disease Ročník 19; číslo 8; s. 969
Hlavní autoři: Isaakidis, P, Casas, E C, Das, M, Tseretopoulou, X, Ntzani, E E, Ford, N
Médium: Journal Article
Jazyk:angličtina
Vydáno: France 01.08.2015
Témata:
Adult
Age Factors
Anti-HIV Agents - therapeutic use
Antitubercular Agents - adverse effects
Antitubercular Agents - therapeutic use
Child
HIV Infections - drug therapy
HIV Infections - epidemiology
Humans
Incidence
Treatment Outcome
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - epidemiology
Tuberculosis, Multidrug-Resistant - mortality
ISSN:1815-7920, 1815-7920
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Shrnutí: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. To systematically assess treatment outcomes among HIV-MDR-TB co-infected patients. 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. 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. 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.
Bibliografie:ObjectType-Article-1
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ObjectType-Review-3
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ISSN:1815-7920
1815-7920
DOI:10.5588/ijtld.15.0123