Antiretroviral Therapy for Prevention of Tuberculosis in Adults with HIV: A Systematic Review and Meta-Analysis
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{"title"=>"Antiretroviral therapy for prevention of tuberculosis in adults with hiv: A systematic review and meta-analysis", "type"=>"generic", "authors"=>[{"first_name"=>"Amitabh B.", "last_name"=>"Suthar", "scopus_author_id"=>"54421168300"}, {"first_name"=>"Stephen D.", "last_name"=>"Lawn", "scopus_author_id"=>"7006905471"}, {"first_name"=>"Julia", "last_name"=>"del Amo", "scopus_author_id"=>"35299126400"}, {"first_name"=>"Haileyesus", "last_name"=>"Getahun", "scopus_author_id"=>"55886401400"}, {"first_name"=>"Christopher", "last_name"=>"Dye", "scopus_author_id"=>"34770166000"}, {"first_name"=>"Delphine", "last_name"=>"Sculier", "scopus_author_id"=>"34168295400"}, {"first_name"=>"Timothy R.", "last_name"=>"Sterling", "scopus_author_id"=>"7103045802"}, {"first_name"=>"Richard E.", "last_name"=>"Chaisson", "scopus_author_id"=>"54790523600"}, {"first_name"=>"Brian G.", "last_name"=>"Williams", "scopus_author_id"=>"55499079300"}, {"first_name"=>"Anthony D.", "last_name"=>"Harries", "scopus_author_id"=>"35233439700"}, {"first_name"=>"Reuben M.", "last_name"=>"Granich", "scopus_author_id"=>"55956234200"}], "year"=>2012, "source"=>"PLoS Medicine", "identifiers"=>{"pmid"=>"22911011", "issn"=>"15491277", "sgr"=>"84864447925", "pui"=>"365352083", "scopus"=>"2-s2.0-84864447925", "isbn"=>"1549-1676 (Electronic)\\r1549-1277 (Linking)", "doi"=>"10.1371/journal.pmed.1001270"}, "id"=>"8fce06ed-19fe-3938-a670-d9b28cb2448a", "abstract"=>"BACKGROUND Human immunodeficiency virus (HIV) infection is the strongest risk factor for developing tuberculosis and has fuelled its resurgence, especially in sub-Saharan Africa. In 2010, there were an estimated 1.1 million incident cases of tuberculosis among the 34 million people living with HIV worldwide. Antiretroviral therapy has substantial potential to prevent HIV-associated tuberculosis. We conducted a systematic review of studies that analysed the impact of antiretroviral therapy on the incidence of tuberculosis in adults with HIV infection. METHODS AND FINDINGS PubMed, Embase, African Index Medicus, LILACS, and clinical trial registries were systematically searched. Randomised controlled trials, prospective cohort studies, and retrospective cohort studies were included if they compared tuberculosis incidence by antiretroviral therapy status in HIV-infected adults for a median of over 6 mo in developing countries. For the meta-analyses there were four categories based on CD4 counts at antiretroviral therapy initiation: (1) less than 200 cells/µl, (2) 200 to 350 cells/µl, (3) greater than 350 cells/µl, and (4) any CD4 count. Eleven studies met the inclusion criteria. Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis in all baseline CD4 count categories: (1) less than 200 cells/µl (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.07 to 0.36), (2) 200 to 350 cells/µl (HR 0.34, 95% CI 0.19 to 0.60), (3) greater than 350 cells/µl (HR 0.43, 95% CI 0.30 to 0.63), and (4) any CD4 count (HR 0.35, 95% CI 0.28 to 0.44). There was no evidence of hazard ratio modification with respect to baseline CD4 count category (p = 0.20). CONCLUSIONS Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis across all CD4 count strata. Earlier initiation of antiretroviral therapy may be a key component of global and national strategies to control the HIV-associated tuberculosis syndemic. REVIEW REGISTRATION International Prospective Register of Systematic Reviews CRD42011001209 Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/antiretroviral-therapy-prevention-tuberculosis-adults-hiv-systematic-review-metaanalysis-1", "reader_count"=>209, "reader_count_by_academic_status"=>{"Unspecified"=>5, "Professor > Associate Professor"=>9, "Librarian"=>1, "Researcher"=>42, "Student > Doctoral Student"=>7, "Student > Ph. D. Student"=>26, "Student > Postgraduate"=>16, "Student > Master"=>57, "Other"=>19, "Student > Bachelor"=>22, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>2, "Professor"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>5, "Professor > Associate Professor"=>9, "Librarian"=>1, "Researcher"=>42, "Student > Doctoral Student"=>7, "Student > Ph. D. 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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/315678", "https://ndownloader.figshare.com/files/315723", "https://ndownloader.figshare.com/files/315765", "https://ndownloader.figshare.com/files/315817", "https://ndownloader.figshare.com/files/315877"], "description"=>"<div><h3>Background</h3><p>Human immunodeficiency virus (HIV) infection is the strongest risk factor for developing tuberculosis and has fuelled its resurgence, especially in sub-Saharan Africa. In 2010, there were an estimated 1.1 million incident cases of tuberculosis among the 34 million people living with HIV worldwide. Antiretroviral therapy has substantial potential to prevent HIV-associated tuberculosis. We conducted a systematic review of studies that analysed the impact of antiretroviral therapy on the incidence of tuberculosis in adults with HIV infection.</p> <h3>Methods and Findings</h3><p>PubMed, Embase, African Index Medicus, LILACS, and clinical trial registries were systematically searched. Randomised controlled trials, prospective cohort studies, and retrospective cohort studies were included if they compared tuberculosis incidence by antiretroviral therapy status in HIV-infected adults for a median of over 6 mo in developing countries. For the meta-analyses there were four categories based on CD4 counts at antiretroviral therapy initiation: (1) less than 200 cells/µl, (2) 200 to 350 cells/µl, (3) greater than 350 cells/µl, and (4) any CD4 count.</p> <h3></h3><p>Eleven studies met the inclusion criteria. Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis in all baseline CD4 count categories: (1) less than 200 cells/µl (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.07 to 0.36), (2) 200 to 350 cells/µl (HR 0.34, 95% CI 0.19 to 0.60), (3) greater than 350 cells/µl (HR 0.43, 95% CI 0.30 to 0.63), and (4) any CD4 count (HR 0.35, 95% CI 0.28 to 0.44). There was no evidence of hazard ratio modification with respect to baseline CD4 count category (<em>p</em> = 0.20).</p> <h3>Conclusions</h3><p>Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis across all CD4 count strata. Earlier initiation of antiretroviral therapy may be a key component of global and national strategies to control the HIV-associated tuberculosis syndemic.</p> <h3>Review Registration</h3><p>International Prospective Register of Systematic Reviews <a href=\"http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42011001209\">CRD42011001209</a></p> <p> <em>Please see later in the article for the Editors' Summary.</em></p> </div>", "links"=>[], "tags"=>["antiretroviral", "tuberculosis", "adults", "systematic", "meta-analysis"], "article_id"=>122317, "categories"=>["Medicine", "Cancer", "Biotechnology"], "users"=>["Amitabh B. Suthar", "Stephen D. Lawn", "Julia del Amo", "Haileyesus Getahun", "Christopher Dye", "Delphine Sculier", "Timothy R. Sterling", "Richard E. Chaisson", "Brian G. Williams", "Anthony D. Harries", "Reuben M. Granich"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001270.s001", "https://dx.doi.org/10.1371/journal.pmed.1001270.s002", "https://dx.doi.org/10.1371/journal.pmed.1001270.s003", "https://dx.doi.org/10.1371/journal.pmed.1001270.s004", "https://dx.doi.org/10.1371/journal.pmed.1001270.s005"], "stats"=>{"downloads"=>37, "page_views"=>17, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Antiretroviral_Therapy_for_Prevention_of_Tuberculosis_in_Adults_with_HIV_A_Systematic_Review_and_Meta_Analysis/122317", "title"=>"Antiretroviral Therapy for Prevention of Tuberculosis in Adults with HIV: A Systematic Review and Meta-Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-07-24 00:38:37"}
  • {"files"=>["https://ndownloader.figshare.com/files/603463"], "description"=>"<p>The circles represent pooled estimates, and the vertical lines represent 95% confidence intervals. The <i>p</i>-value for hazard ratio modification by baseline CD4 count category is 0.20. <i>I</i><sup>2</sup> values for the 0–200, 201–350, and greater than 350 cells/µl categories are 0%, 58%, and 0%, respectively.</p>", "links"=>[], "tags"=>["pooled", "ratios", "tuberculosis", "baseline", "cd4"], "article_id"=>273941, "categories"=>["Biotechnology", "Medicine", "Infectious Diseases"], "users"=>["Amitabh B. Suthar", "Stephen D. Lawn", "Julia del Amo", "Haileyesus Getahun", "Christopher Dye", "Delphine Sculier", "Timothy R. Sterling", "Richard E. Chaisson", "Brian G. Williams", "Anthony D. Harries", "Reuben M. Granich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001270.g003", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Antiretroviral_therapy_use_and_pooled_hazard_ratios_of_tuberculosis_by_baseline_CD4_count_/273941", "title"=>"Antiretroviral therapy use and pooled hazard ratios of tuberculosis by baseline CD4 count.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-07-24 01:05:41"}
  • {"files"=>["https://ndownloader.figshare.com/files/603642"], "description"=>"<p>AFB, acid-fast bacilli; ART, antiretroviral therapy; BMI, body mass index; CDC, US Centers for Disease Control and Prevention; IPT, isoniazid preventive therapy; IQR, interquartile range; NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PCS, prospective cohort study; PI, protease inhibitor; RCS, retrospective cohort study; RCT, randomised controlled trial; SD, standard deviation; TB, tuberculosis; TST, tuberculin skin test.</p>", "links"=>[], "tags"=>["studies", "inclusion"], "article_id"=>274128, "categories"=>["Biotechnology", "Medicine", "Infectious Diseases"], "users"=>["Amitabh B. Suthar", "Stephen D. Lawn", "Julia del Amo", "Haileyesus Getahun", "Christopher Dye", "Delphine Sculier", "Timothy R. Sterling", "Richard E. Chaisson", "Brian G. Williams", "Anthony D. Harries", "Reuben M. Granich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001270.t002", "stats"=>{"downloads"=>2, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Methods_of_studies_meeting_inclusion_criteria_/274128", "title"=>"Methods of studies meeting inclusion criteria.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-07-24 01:08:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/603603"], "description"=>"<p>A score of 0 indicates “no”; a score of 1 or 2 indicates “yes”. Studies scoring ≥67% were considered high methodological quality, 34%–66% were considered moderate methodological quality, and ≤33% were considered low methodological quality. Given that the distribution of possible confounders in randomised controlled trials is related to chance alone, randomised controlled trials were not assessed for confounding.</p><p>ART, antiretroviral therapy; BMI, body mass index; NA, not applicable.</p>", "links"=>[], "tags"=>["studies", "inclusion"], "article_id"=>274090, "categories"=>["Biotechnology", "Medicine", "Infectious Diseases"], "users"=>["Amitabh B. Suthar", "Stephen D. Lawn", "Julia del Amo", "Haileyesus Getahun", "Christopher Dye", "Delphine Sculier", "Timothy R. Sterling", "Richard E. Chaisson", "Brian G. Williams", "Anthony D. Harries", "Reuben M. Granich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001270.t003", "stats"=>{"downloads"=>4, "page_views"=>19, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Newcastle_Ottawa_quality_assessment_scale_for_studies_meeting_inclusion_criteria_/274090", "title"=>"Newcastle-Ottawa quality assessment scale for studies meeting inclusion criteria.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-07-24 01:08:10"}
  • {"files"=>["https://ndownloader.figshare.com/files/603561"], "description"=>"<p>ART, antiretroviral therapy; BMI, body mass index; CDC, US Centers for Disease Control and Prevention; IQR, interquartile range.</p>", "links"=>[], "tags"=>["studies", "inclusion"], "article_id"=>274053, "categories"=>["Biotechnology", "Medicine", "Infectious Diseases"], "users"=>["Amitabh B. Suthar", "Stephen D. Lawn", "Julia del Amo", "Haileyesus Getahun", "Christopher Dye", "Delphine Sculier", "Timothy R. Sterling", "Richard E. Chaisson", "Brian G. Williams", "Anthony D. Harries", "Reuben M. Granich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001270.t001", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_participants_in_studies_meeting_inclusion_criteria_/274053", "title"=>"Characteristics of participants in studies meeting inclusion criteria.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-07-24 01:07:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/603165"], "description"=>"<p>Flow of information through different phases of the review.</p>", "links"=>[], "tags"=>["phases"], "article_id"=>273654, "categories"=>["Biotechnology", "Medicine", "Infectious Diseases"], "users"=>["Amitabh B. Suthar", "Stephen D. Lawn", "Julia del Amo", "Haileyesus Getahun", "Christopher Dye", "Delphine Sculier", "Timothy R. Sterling", "Richard E. Chaisson", "Brian G. Williams", "Anthony D. Harries", "Reuben M. Granich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001270.g001", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flow_of_information_through_different_phases_of_the_review_/273654", "title"=>"Flow of information through different phases of the review.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-07-24 01:00:54"}
  • {"files"=>["https://ndownloader.figshare.com/files/603680"], "description"=>"<p>A score of 0 indicates “no”; a score of 1 indicates “yes”.</p>", "links"=>[], "tags"=>["randomised", "controlled", "trials", "inclusion"], "article_id"=>274163, "categories"=>["Biotechnology", "Medicine", "Infectious Diseases"], "users"=>["Amitabh B. Suthar", "Stephen D. Lawn", "Julia del Amo", "Haileyesus Getahun", "Christopher Dye", "Delphine Sculier", "Timothy R. Sterling", "Richard E. Chaisson", "Brian G. Williams", "Anthony D. Harries", "Reuben M. Granich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001270.t004", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Bias_assessment_for_randomised_controlled_trials_meeting_inclusion_criteria_/274163", "title"=>"Bias assessment for randomised controlled trials meeting inclusion criteria.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-07-24 01:09:23"}
  • {"files"=>["https://ndownloader.figshare.com/files/603261"], "description"=>"<p>The centres of the squares represent study estimates, the centres of the quadrilaterals represent summary estimates, and the horizontal lines represent 95% confidence intervals. PY, person-years; –, data not reported; *, study effect measure is an incidence rate ratio; †, data are from a randomised controlled trial.</p>", "links"=>[], "tags"=>["tuberculosis", "baseline", "cd4"], "article_id"=>273750, "categories"=>["Biotechnology", "Medicine", "Infectious Diseases"], "users"=>["Amitabh B. Suthar", "Stephen D. Lawn", "Julia del Amo", "Haileyesus Getahun", "Christopher Dye", "Delphine Sculier", "Timothy R. Sterling", "Richard E. Chaisson", "Brian G. Williams", "Anthony D. Harries", "Reuben M. Granich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001270.g002", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Antiretroviral_therapy_use_and_hazard_of_tuberculosis_by_baseline_CD4_count_/273750", "title"=>"Antiretroviral therapy use and hazard of tuberculosis by baseline CD4 count.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-07-24 01:02:30"}

PMC Usage Stats | Further Information

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Relative Metric

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