The effect of tuberculosis on mortality in HIV positive people: a meta-analysis.

<h4>Background</h4>Tuberculosis is a leading cause of death in people living with HIV (PLWH). We conducted a meta analysis to assess the effect of tuberculosis on mortality in people living with HIV.<h4>Methods</h4>Meta-analysis of cohort studies assessing the effect of tuber...

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Autores principales:	Masja Straetemans, Ana L Bierrenbach, Nico Nagelkerke, Philippe Glaziou, Marieke J van der Werf
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1321ceaae4004754afd1d240989714e8
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spelling	oai:doaj.org-article:1321ceaae4004754afd1d240989714e82021-11-18T07:00:55ZThe effect of tuberculosis on mortality in HIV positive people: a meta-analysis.1932-620310.1371/journal.pone.0015241https://doaj.org/article/1321ceaae4004754afd1d240989714e82010-12-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21209936/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Tuberculosis is a leading cause of death in people living with HIV (PLWH). We conducted a meta analysis to assess the effect of tuberculosis on mortality in people living with HIV.<h4>Methods</h4>Meta-analysis of cohort studies assessing the effect of tuberculosis on mortality in PLWH. To identify eligible studies we systematically searched electronic databases (until December 2008), performed manual searches of citations from relevant articles, and reviewed conference proceedings. Multivariate hazard ratios (HR) of mortality in PLWH with and without tuberculosis, estimated in individual cohort studies, were pooled using random effect weighting according to "Der Simonian Laird method" if the p-value of the heterogeneity test was <0.05.<h4>Results</h4>Fifteen cohort studies were systematically retrieved. Pooled overall analysis of these 15 studies estimating the effect of tuberculosis on mortality in PLWH showed a Hazard Ratio (HR) of 1.8 (95% confidence interval (CI): 1.4-2.3). Subanalysis of 8 studies in which the cohort was not exposed to highly active antiretroviral therapy (HAART) showed an HR of 2.6 (95% CI: 1.8-3.6). Subanalysis of 6 studies showed that tuberculosis did not show an effect on mortality in PLWH exposed to HAART: HR 1.1 (95% CI: 0.9-1.3).<h4>Conclusion</h4>These results provide an indication of the magnitude of benefit to an individual that could have been expected if tuberculosis had been prevented. It emphasizes the need for additional studies assessing the effect of preventing tuberculosis or early diagnosis and treatment of tuberculosis in PLWH on reducing mortality. Furthermore, the results of the subgroup analyses in cohorts largely exposed to HAART provide additional support to WHO's revised guidelines, which include promoting the initiation of HAART for PLWH co-infected with tuberculosis. The causal effect of tuberculosis on mortality in PLWH exposed to HAART needs to be further evaluated once the results of more cohort studies become available.Masja StraetemansAna L BierrenbachNico NagelkerkePhilippe GlaziouMarieke J van der WerfPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 5, Iss 12, p e15241 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Masja Straetemans Ana L Bierrenbach Nico Nagelkerke Philippe Glaziou Marieke J van der Werf The effect of tuberculosis on mortality in HIV positive people: a meta-analysis.
description	<h4>Background</h4>Tuberculosis is a leading cause of death in people living with HIV (PLWH). We conducted a meta analysis to assess the effect of tuberculosis on mortality in people living with HIV.<h4>Methods</h4>Meta-analysis of cohort studies assessing the effect of tuberculosis on mortality in PLWH. To identify eligible studies we systematically searched electronic databases (until December 2008), performed manual searches of citations from relevant articles, and reviewed conference proceedings. Multivariate hazard ratios (HR) of mortality in PLWH with and without tuberculosis, estimated in individual cohort studies, were pooled using random effect weighting according to "Der Simonian Laird method" if the p-value of the heterogeneity test was <0.05.<h4>Results</h4>Fifteen cohort studies were systematically retrieved. Pooled overall analysis of these 15 studies estimating the effect of tuberculosis on mortality in PLWH showed a Hazard Ratio (HR) of 1.8 (95% confidence interval (CI): 1.4-2.3). Subanalysis of 8 studies in which the cohort was not exposed to highly active antiretroviral therapy (HAART) showed an HR of 2.6 (95% CI: 1.8-3.6). Subanalysis of 6 studies showed that tuberculosis did not show an effect on mortality in PLWH exposed to HAART: HR 1.1 (95% CI: 0.9-1.3).<h4>Conclusion</h4>These results provide an indication of the magnitude of benefit to an individual that could have been expected if tuberculosis had been prevented. It emphasizes the need for additional studies assessing the effect of preventing tuberculosis or early diagnosis and treatment of tuberculosis in PLWH on reducing mortality. Furthermore, the results of the subgroup analyses in cohorts largely exposed to HAART provide additional support to WHO's revised guidelines, which include promoting the initiation of HAART for PLWH co-infected with tuberculosis. The causal effect of tuberculosis on mortality in PLWH exposed to HAART needs to be further evaluated once the results of more cohort studies become available.
format	article
author	Masja Straetemans Ana L Bierrenbach Nico Nagelkerke Philippe Glaziou Marieke J van der Werf
author_facet	Masja Straetemans Ana L Bierrenbach Nico Nagelkerke Philippe Glaziou Marieke J van der Werf
author_sort	Masja Straetemans
title	The effect of tuberculosis on mortality in HIV positive people: a meta-analysis.
title_short	The effect of tuberculosis on mortality in HIV positive people: a meta-analysis.
title_full	The effect of tuberculosis on mortality in HIV positive people: a meta-analysis.
title_fullStr	The effect of tuberculosis on mortality in HIV positive people: a meta-analysis.
title_full_unstemmed	The effect of tuberculosis on mortality in HIV positive people: a meta-analysis.
title_sort	effect of tuberculosis on mortality in hiv positive people: a meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/1321ceaae4004754afd1d240989714e8
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The effect of tuberculosis on mortality in HIV positive people: a meta-analysis.

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