TB as a cause of hospitalization and in‐hospital mortality among people living with HIV worldwide: a systematic review and meta‐analysis

Abstract

IntroductionDespite significant progress in improving access to antiretroviral therapy over the past decade, substantial numbers of people living with HIV (PLHIV) in all regions continue to experience severe illness and require hospitalization. We undertook a global review assessing the proportion of hospitalizations and in-hospital deaths because of tuberculosis (TB) in PLHIV.MethodsSeven databases were searched to identify studies reporting causes of hospitalizations among PLHIV from 1 January 2007 to 31 January 2015 irrespective of age, geographical region or language. The proportion of hospitalizations and in-hospital mortality attributable to TB was estimated using random effects meta-analysis.ResultsFrom an initial screen of 9049 records, 66 studies were identified, providing data on 35,845 adults and 2792 children across 42 countries. Overall, 17.7% (95% CI 16.0 to 20.2%) of all adult hospitalizations were because of TB, making it the leading cause of hospitalization overall; the proportion of adult hospitalizations because of TB exceeded 10% in all regions except the European region. Of all paediatric hospitalizations, 10.8% (95% CI 7.6 to 13.9%) were because of TB. There was insufficient data among children for analysis by region. In-hospital mortality attributable to TB was 24.9% (95% CI 19.0 to 30.8%) among adults and 30.1% (95% CI 11.2 to 48.9%) among children.DiscussionTB remains a leading cause of hospitalization and in-hospital death among adults and children living with HIV worldwide.

Scale-up of ART in Malawi has reduced case notification rates in HIV-positive and HIV-negative tuberculosis

“…TB is also a major cause of hospitalisation and in-hospital mortality in adults and children globally, and early ART is likely to substantially reduce this burden. 25 Second, there are plans to scale up IPT in a phased manner around the country. Two randomised controlled studies in Ivory Coast and South Africa have demonstrated that adding IPT to ART in PLHIV can lead to an additional reduction in TB cases of 30% or higher, 7,26 and this intervention may add to the TB preventive effect of ART.…”

Autopsy Prevalence of Tuberculosis and Other Potentially Treatable Infections among Adults with Advanced HIV Enrolled in Out-Patient Care in South Africa

“…Pathological autopsy studies involving HIV-positive individuals have consistently found tuberculosis (TB) to be the leading cause of death and the overall prevalence of active TB to be extremely high, much of it undiagnosed antemortem [4–7]. The World Health Organization (WHO) aims to reduce TB deaths by 95% by 2035 [8], but questions remain around current estimates of TB deaths and the methods used to obtain them [9].…”

Enhanced Prophylaxis plus Antiretroviral Therapy for Advanced HIV Infection in Africa

“…Among these patients, approximately 10% die during the first 3 months after ART initiation 5–8. Causes of death are multifactorial and similar between adults and older children,7 with severe bacterial infection,3,9 tuberculosis,8,10,11 and cryptococcal infection12,13 playing prominent roles. The development or exacerbation of such infections has been linked in part to the immune reconstitution inflammatory syndrome (IRIS) associated with the initiation of ART.…”