Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis

Abstract

S U M M A R Y B A C K G R O U N D :The incidence of multidrug-resistant tuberculosis (MDR-TB) is increasing in high human immunodeficiency virus (HIV) prevalence settings, with high associated mortality. Treatment outcomes in HIVco-infected adults and children are poorly documented. O B J E C T I V E : To systematically assess treatment outcomes among HIV-MDR-TB co-infected patients. M E T H O D S :We searched two databases and the proceedings of an annual international conference up to November 2014 for studies reporting on major clinical outcomes among HIV-MDR-TB-co-infected adults and children, and pooled the results using random-effects meta-analysis. R E S U LT S : Of 4812 abstracts and articles screened, 30 studies providing data on 2578 adults and 147 children were included. Overall pooled treatment success was 56.9% (95% confidence interval [CI] 46.2-67.6), 49.9% (95%CI 38.5-61.2) among adults and 83.4% (95%CI 74.7-92) among children. Mortality was 38% in adults (95%CI 28-48.1) and 11.4% (95%CI 5.8-17.1) in children. Loss to follow-up was higher among adults (16.1%, 95%CI 9-23.2) than among children (3.9%, 95%CI 0.9-6.9). Adverse events were experienced by the majority of patients; however, this was inconsistently documented.

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

“…For this reason, it is imperative that all people with MDR tuberculosis be screened for HIV at the time of diagnosis. 321 Management of HIV-infected patients is complicated by several factors, including higher rates of drug toxicity, HIV-related organ dysfunction (eg, nephropathy, neuropathy, and anaemia), drug-drug interactions and overlapping toxicities, pill burden, and immune reconstitution inflammatory syndrome 322 (table 7). However, when there is good control of HIV disease, excellent treatment outcomes can be achieved in persons with drug-resistant tuberculosis and HIV.…”

Treatment Outcomes of Children With HIV Infection and Drug-resistant TB in Three Provinces in South Africa, 2005–2008

“…Previous studies have demonstrated that mortality among children with DR TB in South Africa differs by province (12%–31%), but overall treatment success rates (70%–83%) can be similar to, if not better than, those seen in adults (28–30). The objective of this analysis was to assess the association between treatment outcomes with HIV status and other risk factors among children and adolescents with MDR TB.…”

Current therapies for the treatment of multidrug-resistant tuberculosis in children in India

“…A systematic review published in 2015 states that the mortality in children with MDR-TB and HIV infection is twice as compared to the HIV-uninfected children with MDR-TB [84]. There are some special considerations to be kept in mind while managing HIV and MDR-TB coinfection [13,54].…”