The Impact of Antiretroviral Therapy on Mortality in HIV Positive People during Tuberculosis Treatment: A Systematic Review and Meta-Analysis
The Impact of Antiretroviral Therapy on Mortality in HIV Positive People during Tuberculosis Treatment: A Systematic Review and Meta-Analysis
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DOI：
10.1371/journal.pone.0112017
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发表时间：
2014-11-12
期刊：
影响因子：
3.7
通讯作者：
Houben, Rein M. G. J.
中科院分区：
文献类型：
--
作者：
Odone, Anna;Amadasi, Silvia;Houben, Rein M. G. J.
目的：为了量化抗逆转录病毒治疗（ART）对结核病（TB）治疗期间HIV阳性患者死亡率的影响，设计：我们进行了系统的文献回顾和荟萃分析。从1996年到2013年2月15日发表的研究，通过搜索电子资源（Pubmed和Embase）和会议书籍，手动搜索参考文献和专家咨询来确定。使用随机效应荟萃分析获得对感兴趣的结果的汇总估计。受试者：研究人群包括在TB治疗之前或期间接受ART的个体。主要结果测量：主要结果测量是：结核病病死率，定义为在结核病治疗期间死亡的个人比例，如果还报告了未接受抗逆转录病毒疗法的艾滋病毒抗体阳性者的死亡率，（ii）ART状态下结核病治疗期间死亡的相对风险。结果：21项研究纳入系统评价。随机效应汇总荟萃分析估计CFR在8%至14%之间（汇总估计值为11%）。在HIV阳性的结核病病例中，接受抗逆转录病毒治疗的患者在结核病治疗期间的死亡率降低了44%至71%（RR = 0.42，95%CI：0.29-0.56）。结论：在临床环境中，在结核病治疗之前或期间开始抗逆转录病毒治疗可将结核病治疗期间的死亡风险降低约五分之三。国家方案应继续扩大抗逆转录病毒疗法对艾滋病毒阳性患者的覆盖面，以控制双重流行病。
Objective: To quantify the impact of antiretroviral therapy (ART) on mortality in HIV-positive people during tuberculosis (TB) treatment.Design: We conducted a systematic literature review and meta-analysis. Studies published from 1996 through February 15, 2013, were identified by searching electronic resources (Pubmed and Embase) and conference books, manual searches of references, and expert consultation. Pooled estimates for the outcome of interest were acquired using random effects meta-analysis.Subjects: The study population included individuals receiving ART before or during TB treatment.Main Outcome Measures: Main outcome measures were: (i) TB-case fatality ratio (CFR), defined as the proportion of individuals dying during TB treatment and, if mortality in HIV-positive people not on ART was also reported, (ii) the relative risk of death during TB treatment by ART status.Results: Twenty-one studies were included in the systematic review. Random effects pooled meta-analysis estimated the CFR between 8% and 14% (pooled estimate 11%). Among HIV-positive TB cases, those receiving ART had a reduction in mortality during TB treatment of between 44% and 71% (RR = 0.42, 95% CI: 0.29-0.56).Conclusion: Starting ART before or during TB therapy reduces the risk of death during TB treatment by around three-fifths in clinical settings. National programmes should continue to expand coverage of ART for HIV positive in order to control the dual epidemic.