The impact of HIV and antiretroviral therapy on TB risk in children: a systematic review and meta-analysis.
The impact of HIV and antiretroviral therapy on TB risk in children: a systematic review and meta-analysis.
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DOI：
10.1136/thoraxjnl-2016-209421
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发表时间：
2017-06
期刊：
影响因子：
10
通讯作者：
Seddon JA
中科院分区：
文献类型：
--
作者：
Dodd PJ;Prendergast AJ;Beecroft C;Kampmann B;Seddon JA
儿童（<15岁）在感染后易患结核病，但尚无系统性综述或荟萃分析量化艾滋病毒相关免疫抑制或抗逆转录病毒治疗（ART）对其结核病发病率的影响。 确定艾滋病毒感染和抗逆转录病毒疗法对儿童结核病发病风险的影响。我们在MEDLINE和Embase中检索了测量儿童结核病例（“结核队列”）和报告结核发病率的儿童艾滋病毒队列（“艾滋病毒队列”）中艾滋病毒流行率的研究。使用Newcastle-Ottawa工具评估研究质量。对结核病队列与对照组进行荟萃分析，以确定结核病与艾滋病毒的发病率比（IRR）。对HIV队列数据进行荟萃分析，以估计log-IRR与CD4%的趋势、免疫学分期的相对发病率和ART相关的结核病保护作用。纳入了42个结核病队列和22个艾滋病毒队列。在8个TB队列中，TB的IRR为7.9（95% CI 4.5 - 13.7）。HIV感染儿童的CD4%每增加一个百分点，IRR降低0.94（95%可信区间：0.83-1.07）。严重免疫抑制儿童的结核病发病率是非显著免疫抑制儿童的5.0倍（95%CI 4.0 - 6.0）。接受抗逆转录病毒治疗的艾滋病毒感染儿童的结核病发病率较低（风险比：0.30; 95%CI 0.21 - 0.39）。在开始抗逆转录病毒治疗后，TB发病率在12个月内迅速下降，HR为0.10（95% CI 0.04 - 0.25）。 艾滋病毒是儿童结核病的一个潜在危险因素，抗逆转录病毒疗法具有很强的保护作用。在感染艾滋病毒的儿童中，早期诊断和开始抗逆转录病毒治疗可降低结核病风险。CRD 42014014276。
Children (<15 years) are vulnerable to TB disease following infection, but no systematic review or meta-analysis has quantified the effects of HIV-related immunosuppression or antiretroviral therapy (ART) on their TB incidence. Determine the impact of HIV infection and ART on risk of incident TB disease in children. We searched MEDLINE and Embase for studies measuring HIV prevalence in paediatric TB cases (‘TB cohorts’) and paediatric HIV cohorts reporting TB incidence (‘HIV cohorts’). Study quality was assessed using the Newcastle-Ottawa tool. TB cohorts with controls were meta-analysed to determine the incidence rate ratio (IRR) for TB given HIV. HIV cohort data were meta-analysed to estimate the trend in log-IRR versus CD4%, relative incidence by immunological stage and ART-associated protection from TB. 42 TB cohorts and 22 HIV cohorts were included. In the eight TB cohorts with controls, the IRR for TB was 7.9 (95% CI 4.5 to 13.7). HIV-infected children exhibited a reduction in IRR of 0.94 (95% credible interval: 0.83–1.07) per percentage point increase in CD4%. TB incidence was 5.0 (95% CI 4.0 to 6.0) times higher in children with severe compared with non-significant immunosuppression. TB incidence was lower in HIV-infected children on ART (HR: 0.30; 95% CI 0.21 to 0.39). Following initiation of ART, TB incidence declined rapidly over 12 months towards a HR of 0.10 (95% CI 0.04 to 0.25). HIV is a potent risk factor for paediatric TB, and ART is strongly protective. In HIV-infected children, early diagnosis and ART initiation reduces TB risk. CRD42014014276.
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影响因子：
3
作者：
Bamford A;Turkova A;Lyall H;Foster C;Klein N;Bastiaans D;Burger D;Bernadi S;Butler K;Chiappini E;Clayden P;Della Negra M;Giacomet V;Giaquinto C;Gibb D;Galli L;Hainaut M;Koros M;Marques L;Nastouli E;Niehues T;Noguera-Julian A;Rojo P;Rudin C;Scherpbier HJ;Tudor-Williams G;Welch SB;(PENTA Steering Committee)
通讯作者：
(PENTA Steering Committee)
影响因子：
7.7
作者：
Edmonds, Andrew;Lusiama, Jean;Behets, Frieda
通讯作者：
Behets, Frieda
DOI：
10.1097/00042560-199610010-00006
发表时间：
1996-10-01
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY
影响因子：
--
作者：
Espinal, MA;Reingold, AL;Gonzalez, G
通讯作者：
Gonzalez, G
影响因子：
3.6
作者：
Ciaranello, Andrea;Lu, Zhigang;Wools-Kaloustian, Kara
通讯作者：
Wools-Kaloustian, Kara
影响因子：
3.6
作者：
Dankner, WM;Lindsey, JC;Levin, MJ
通讯作者：
Levin, MJ