Early versus Delayed Antiretroviral Therapy for HIV and Tuberculosis Co-Infected Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

ObjectiveTo compare important clinical outcomes between early and delayed initiation of antiretroviral therapy (ART) in adults who had a co-infection of human immunodeficiency virus (HIV) and tuberculosis (TB).MethodsWe performed a systematic search for relevant publications on PubMed, EMBASE, and the International Clinical Trials Registry Platform. We included randomized controlled trials (RCTs) that compared early ART initiation (within four weeks after anti-TB treatment starting) and delayed ART initiation (after eight weeks but less than twelve weeks of anti-TB treatment starting) in the course of TB treatment. Pooled estimates with corresponding 95% confidence interval (95%CI) were calculated with random-effects model. Sensitivity analysis was performed to investigate the stability of pooled estimates.ResultsA meta-analysis was evaluated from six RCTs with 2272 participants. Compared to delayed ART initiation, early ART initiation significantly reduces all-cause mortality in HIV-positive patients with TB [incidence rate ratio (IRR) 0.75, 95%CI 0.59 to 0.95; I2 = 0.00%; p = 0.67], even though there is an increased risk for IRD [IRR 2.29, 95%CI 1.81 to 2.91; I22 = 0.00%; p = 0.56]. Additionally, early ART initiation was not associated with an increased risk for grade 3-4 drug-related adverse events [IRR 0.99, 95%CI 0.83 to 1.18; I2 = 0.00%; p = 0.56].ConclusionsAlthough limited evidence, our results provide support for early ART initiation in the course of anti-TB treatment. However, more well-designed cohort or intervention studies are required to further confirm our findings.

Management of hospitalized drug sensitive pulmonary tuberculosis patients during the Hajj mass gathering: A cross sectional study

“…Yet, HIV could be a more frequent comorbidity among pilgrims who arrive with active TB from areas with high HIV disease prevalence [1]. More so, a missed or delayed HIV diagnosis in a TB patient stalls the commencement of appropriate treatment and results in poor outcomes for the patient, community and health system [35]. Therefore, healthcare providers in KSA ought to be trained and guided to conduct screening for HIV and other comorbidities in all suspected TB patients irrespective of their nationality.…”

The cursed duet today: Tuberculosis and HIV-coinfection

“…The WHO recommends that all HIV-positive individuals with drug-sensitive or drug-resistant active TB disease should begin ART within the first 2 months of TB treatment, regardless of their CD4+ T cell count. Randomised controlled trials [54,[84][85][86][87], systematic reviews and metaanalyses [88,89] confirm the benefit of combining HIV and TB therapy in reducing mortality rates. Preferred ART regimens are described in the 2016 WHO guidelines [16]; in adults, first-line treatment comprises a combination of two nucleoside reverse-transcriptase inhibitors and a nonnucleoside reverse-transcriptase inhibitor or an integrase inhibitor.…”

“…The risk of developing IRIS increases with lower CD4+ cell counts at diagnosis. Initiating ART treatment during treatment of TB has been shown to decrease mortality rates, particularly in those with low CD4+ cell counts (< 50 cells/μl)) [142,[86][87][88].…”

Role of MRP transporters in regulating antimicrobial drug inefficacy and oxidative stress-induced pathogenesis during HIV-1 and TB infections

“…Approximately one third of the HIV-1 positive patients are also infected with TB (Ritchie et al, 2014 ). There is limited evidence that early intervention with HAART results in a better outcome in TB infection of dual infected patients (Yan et al, 2015 ). It has been suggested that HIV infection impairs host immune response to TB due to an over excitation of cytokine milieu in the co-infected host (Chetty et al, 2014 ).…”