What is the optimum time to start antiretroviral therapy in people with HIV and tuberculosis coinfection? A systematic review and meta-analysis.
What is the optimum time to start antiretroviral therapy in people with HIV and tuberculosis coinfection? A systematic review and meta-analysis.
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DOI：
10.1002/jia2.25772
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发表时间：
2021-07
影响因子：
6
通讯作者：
MacPherson P
中科院分区：
文献类型：
--
作者：
Burke RM;Rickman HM;Singh V;Corbett EL;Ayles H;Jahn A;Hosseinipour MC;Wilkinson RJ;MacPherson P
艾滋病毒和结核病经常同时被诊断出来。2021年3月，世界卫生组织建议，抗逆转录病毒治疗（ART）应在结核病治疗开始后两周内开始，无论CD 4计数如何。我们评估了早期ART是否改善了新诊断的HIV和结核病患者的结局。我们通过检索9个数据库进行了系统回顾，比较了HIV和结核病患者早期ART和晚期ART启动的试验。我们纳入了从数据库建立到2021年3月12日发表的研究。我们比较了结核病治疗后4周内的ART与4周以上的ART，2周内的ART与2 - 8周的ART，并按CD 4计数进行分层分析。主要结局是死亡;次要结局包括IRIS和AIDS定义事件。我们使用随机效应Meta分析汇总了效应估计值。我们筛选了2468篇摘要，并确定了9项试验。在所有CD 4计数的人群中，早期ART（≤4周）与晚期ART（>4周）的死亡率没有差异（风险差异[RD] 0%，95%置信区间[CI]-2%至+1%）。在CD 4计数≤50个细胞/mm 3的人群中，早期ART（≤4周）可降低死亡风险（RD − 6%，−10%至−1%）。在所有CD 4计数的人群中，早期ART（≤4周）增加了IRIS的风险（RD +6%，95%CI +2%至10%），并降低了AIDS定义事件的发生率（RD − 2%，95%CI −4%至0%）。当试验仅限于允许比较两周内ART与两周至八周ART的四项试验时，结果相似。在2004年至2014年期间进行了试验，然后建议在任何CD 4计数下治疗艾滋病毒或在没有结核病的人中快速开始ART。没有试验包括儿童或孕妇。没有试验在ART方案中纳入整合酶抑制剂。早期抗逆转录病毒治疗并没有改变患有结核病的艾滋病毒感染者的总体死亡风险。出于后勤和患者偏好的原因，结核病和艾滋病毒感染者较早开始抗逆转录病毒治疗可能优于较晚开始抗逆转录病毒治疗。
HIV and tuberculosis are frequently diagnosed concurrently. In March 2021, World Health Organization recommended that antiretroviral therapy (ART) should be started within two weeks of tuberculosis treatment start, at any CD4 count. We assessed whether earlier ART improved outcomes in people with newly diagnosed HIV and tuberculosis. We did a systematic review by searching nine databases for trials that compared earlier ART to later ART initiation in people with HIV and tuberculosis. We included studies published from database inception to 12 March 2021. We compared ART within four weeks versus ART more than four weeks after TB treatment, and ART within two weeks versus ART between two and eight weeks, and stratified analysis by CD4 count. The main outcome was death; secondary outcomes included IRIS and AIDS‐defining events. We pooled effect estimates using random effects meta‐analysis. We screened 2468 abstracts, and identified nine trials. Among people with all CD4 counts, there was no difference in mortality by earlier ART (≤4 week) versus later ART (>4 week) (risk difference [RD] 0%, 95% confidence interval [CI] −2% to +1%). Among people with CD4 count ≤50 cells/mm3, earlier ART (≤4 weeks) reduced risk of death (RD −6%, −10% to −1%). Among people with all CD4 counts earlier ART (≤4 weeks) increased the risk of IRIS (RD +6%, 95% CI +2% to +10%) and reduced the incidence of AIDS‐defining events (RD −2%, 95% CI −4% to 0%). Results were similar when trials were restricted to the four trials which permitted comparison of ART within two weeks to ART between two and eight weeks. Trials were conducted between 2004 and 2014, before recommendations to treat HIV at any CD4 count or to rapidly start ART in people without TB. No trials included children or pregnant women. No trials included integrase inhibitors in ART regimens. Earlier ART did not alter risk of death overall among people living with HIV who had TB disease. For logistical and patient preference reasons, earlier ART initiation for everyone with TB and HIV may be preferred to later ART.
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影响因子：
2.2
作者：
Nachega JB;Morroni C;Chaisson RE;Goliath R;Efron A;Ram M;Maartens G
通讯作者：
Maartens G
DOI：
10.1056/nejmoa1013607
发表时间：
2011-10-20
期刊：
The New England journal of medicine
影响因子：
--
作者：
Havlir DV;Kendall MA;Ive P;Kumwenda J;Swindells S;Qasba SS;Luetkemeyer AF;Hogg E;Rooney JF;Wu X;Hosseinipour MC;Lalloo U;Veloso VG;Some FF;Kumarasamy N;Padayatchi N;Santos BR;Reid S;Hakim J;Mohapi L;Mugyenyi P;Sanchez J;Lama JR;Pape JW;Sanchez A;Asmelash A;Moko E;Sawe F;Andersen J;Sanne I;AIDS Clinical Trials Group Study A5221
通讯作者：
AIDS Clinical Trials Group Study A5221
DOI：
10.1056/nejmoa1600693
发表时间：
2016-09-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Cohen MS;Chen YQ;McCauley M;Gamble T;Hosseinipour MC;Kumarasamy N;Hakim JG;Kumwenda J;Grinsztejn B;Pilotto JH;Godbole SV;Chariyalertsak S;Santos BR;Mayer KH;Hoffman IF;Eshleman SH;Piwowar-Manning E;Cottle L;Zhang XC;Makhema J;Mills LA;Panchia R;Faesen S;Eron J;Gallant J;Havlir D;Swindells S;Elharrar V;Burns D;Taha TE;Nielsen-Saines K;Celentano DD;Essex M;Hudelson SE;Redd AD;Fleming TR;HPTN 052 Study Team
通讯作者：
HPTN 052 Study Team
影响因子：
3.7
作者：
Sinha S;Shekhar RC;Singh G;Shah N;Ahmad H;Kumar N;Sharma SK;Samantaray JC;Ranjan S;Ekka M;Sreenivas V;Mitsuyasu RT
通讯作者：
Mitsuyasu RT
影响因子：
56.3
作者：
Mfinanga, Sayoki G.;Kirenga, Bruce J.;Onyebujoh, Philip
通讯作者：
Onyebujoh, Philip