Is HIV Infection a Risk Factor for Multi-Drug Resistant Tuberculosis? A Systematic Review

Abstract

BackgroundTuberculosis (TB) is an important cause of human suffering and death. Human immunodeficiency virus (HIV), multi-drug resistant TB (MDR-TB), and extensive drug resistant tuberculosis (XDR-TB) have emerged as threats to TB control. The association between MDR-TB and HIV infection has not yet been fully investigated. We conducted a systematic review and meta-analysis to summarize the evidence on the association between HIV infection and MDR-TB.Methods and ResultsOriginal studies providing Mycobacterium tuberculosis resistance data stratified by HIV status were identified using MEDLINE and ISI Web of Science. Crude MDR-TB prevalence ratios were calculated and analyzed by type of TB (primary or acquired), region and study period. Heterogeneity across studies was assessed, and pooled prevalence ratios were generated if appropriate. No clear association was found between MDR-TB and HIV infection across time and geographic locations. MDR-TB prevalence ratios in the 32 eligible studies, comparing MDR-TB prevalence by HIV status, ranged from 0.21 to 41.45. Assessment by geographical region or study period did not reveal noticeable patterns. The summary prevalence ratios for acquired and primary MDR-TB were 1.17 (95% CI 0.86, 1.6) and 2.72 (95% CI 2.03, 3.66), respectively. Studies eligible for review were few considering the size of the epidemics. Most studies were not adjusted for confounders and the heterogeneity across studies precluded the calculation of a meaningful overall summary measure.ConclusionsWe could not demonstrate an overall association between MDR-TB and HIV or acquired MDR-TB and HIV, but our results suggest that HIV infection is associated with primary MDR-TB. Future well-designed studies and surveillance in all regions of the world are needed to better clarify the relationship between HIV infection and MDR-TB.

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

“…A systematic review 31 found that several studies have reported a high proportion of resistant cases in patients with tuberculosis co-infected with HIV in specific outbreak settings such as prisons and hospitals, but few studies have systematically compared prevalence of multidrug resistance between HIV-infected and uninfected patients after controlling for other factors. A 2009 systematic review that summarised 32 eligible studies noted a statistically significant association between HIV co-infection and primary but not secondary multidrug resistance, but most of the studies included in the analysis were not adjusted for confounders.…”

“…A 2009 systematic review that summarised 32 eligible studies noted a statistically significant association between HIV co-infection and primary but not secondary multidrug resistance, but most of the studies included in the analysis were not adjusted for confounders. 31 A study in Kazakhstan showed that, although risk factors for HIV and MDR tuberculosis largely overlapped, HIV was not a risk factor for MDR once the socioeconomic risk factors for both diseases had been taken into account. 32 Studies on diabetes as a risk factor for MDR tuberculosis have been similarly heterogeneous.…”

Antitubercular therapy induced liver function tests abnormalities in human immunodeficiency virus infected individuals

“…Irrespective of the CD4 cell count and ART therapy, the risk of death in co-infected individuals is twice that of HIV positive patients without TB. 15 While HIV infection speeds up the progression from latent to active TB almost 12-20 times, 1,16 TB bacteria accelerates the progress of HIV infection to full blown AIDS. 17 In 2013, an estimated 1.1/9 million (13%) people who developed TB, were HIV positive.…”

Prevalence and Correlates of TB and HIV Co-infection Among People Living with HIV/AIDs at the DLHM Hospital, Calabar

“…Also, in co-infected individuals the risk of death is twice that of HIV infected individuals without TB, even when CD4 cell count and antiretroviral therapy are taken into account. [8] Many people are not aware of being infected with tubercle bacillus; the infection thus becomes reactivated by other infections such as the HIV when the body immune system is weakened. People living with HIV or immunosuppressed patients due to drugs seem more vulnerable to tuberculosis (TB) than HIV uninfected persons.…”

“…Overall it is considered that the lifetime uncertainty for HIV negative individual of progressing from latent to active TB is about 5-10%, whereas for HIV positive people this same figure is the annual risk. [8] Without proper treatment, an estimated 90 percent of persons living with HIV die within months after contracting tuberculosis. [1] The initiation of highly active antiretroviral therapy (HAART) in persons co-infected with tuberculosis can cause an immune reconstitution inflammatory syndrome with a worsening, in some cases severe worsening, of tuberculosis infection and symptoms.…”