Antiretroviral therapy for prevention of tuberculosis in adults with HIV : a systematic review and Meta-Analysis

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dc.contributor.authorSuthar, Amitabh B.en_ZA
dc.contributor.authorLawn, Stephen D.en_ZA
dc.contributor.authorDel Amo, Juliaen_ZA
dc.contributor.authorGetahun, Haileyesusen_ZA
dc.contributor.authorDye, Christopheren_ZA
dc.contributor.authorSculier, Delphineen_ZA
dc.contributor.authorSterling, Timothy R.en_ZA
dc.contributor.authorChaisson, Richard E.en_ZA
dc.contributor.authorWilliams, Brian G.en_ZA
dc.contributor.authorHarries, Anthony D.en_ZA
dc.contributor.authorGranich, Reuben M.en_ZA
dc.date.accessioned2013-02-26T06:56:53Z
dc.date.available2013-02-26T06:56:53Z
dc.date.issued2012-07
dc.descriptionCITATION: Suthar, A. B. 2012. Antiretroviral therapy for prevention of tuberculosis in adults with HIV : a systematic review and Meta-Analysis. PLoS Medicine, 9(7): 1-15, doi: 10.1371/journal.pmed.1001270.
dc.descriptionThe original publication is available at http://journals.plos.org/plosmedicine
dc.description.abstractBackground: Human immunodeficiency virus (HIV) infection is the strongest risk factor for developing tuberculosis and has fuelled its resurgence, especially in sub-Saharan Africa. In 2010, there were an estimated 1.1 million incident cases of tuberculosis among the 34 million people living with HIV worldwide. Antiretroviral therapy has substantial potential to prevent HIV-associated tuberculosis. We conducted a systematic review of studies that analysed the impact of antiretroviral therapy on the incidence of tuberculosis in adults with HIV infection. Methods and Findings: PubMed, Embase, African Index Medicus, LILACS, and clinical trial registries were systematically searched. Randomised controlled trials, prospective cohort studies, and retrospective cohort studies were included if they compared tuberculosis incidence by antiretroviral therapy status in HIV-infected adults for a median of over 6 mo in developing countries. For the meta-analyses there were four categories based on CD4 counts at antiretroviral therapy initiation: (1) less than 200 cells/ml, (2) 200 to 350 cells/ml, (3) greater than 350 cells/ml, and (4) any CD4 count. Eleven studies met the inclusion criteria. Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis in all baseline CD4 count categories: (1) less than 200 cells/ml (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.07 to 0.36), (2) 200 to 350 cells/ml (HR 0.34, 95% CI 0.19 to 0.60), (3) greater than 350 cells/ml (HR 0.43, 95% CI 0.30 to 0.63), and (4) any CD4 count (HR 0.35, 95% CI 0.28 to 0.44). There was no evidence of hazard ratio modification with respect to baseline CD4 count category (p = 0.20). Conclusions: Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis across all CD4 count strata. Earlier initiation of antiretroviral therapy may be a key component of global and national strategies to control the HIV-associated tuberculosis syndemic.en_ZA
dc.description.versionPublisher's versionen_ZA
dc.format.extent15 pages
dc.identifier.citationSuthar, A. B. 2012. Antiretroviral therapy for prevention of tuberculosis in adults with HIV : a systematic review and Meta-Analysis. PLoS Medicine, 9(7): 1-15, doi: 10.1371/journal.pmed.1001270
dc.identifier.issn1549-1676 (online)
dc.identifier.issn1549-1277 (print)
dc.identifier.otherdoi: 10.1371/journal.pmed.1001270
dc.identifier.urihttp://hdl.handle.net/10019.1/79609
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectHIV-positive personsen_ZA
dc.subjectHuman immunodeficiency virusen_ZA
dc.subjectTuberculosis -- Africa, Sub-Saharanen_ZA
dc.subjectAntiretroviral agentsen_ZA
dc.subjectMeta-analysesen_ZA
dc.subjectBaseline CD4 counten_ZA
dc.titleAntiretroviral therapy for prevention of tuberculosis in adults with HIV : a systematic review and Meta-Analysisen_ZA
dc.typeArticleen_ZA
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