The Effect of Tuberculosis on Mortality in HIV Positive People: A Meta-Analysis
Publication Date
December 30, 2010
Journal
PLOS ONE
Authors
Masja Straetemans, Ana L. Bierrenbach, Nico Nagelkerke, Philippe Glaziou, et al
Volume
5
Issue
12
Pages
e15241
DOI
https://dx.plos.org/10.1371/journal.pone.0015241
Publisher URL
http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0015241
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/21209936
PubMed Central
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012688
Europe PMC
http://europepmc.org/abstract/MED/21209936
Web of Science
000285793600015
Scopus
78651243906
Mendeley
http://www.mendeley.com/research/effect-tuberculosis-mortality-hiv-positive-people-metaanalysis
Events
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Mendeley | Further Information

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Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/403679", "https://ndownloader.figshare.com/files/403712"], "description"=>"<div><h3>Background</h3><p>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.</p> <h3>Methods</h3><p>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.</p> <h3>Results</h3><p>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).</p> <h3>Conclusion</h3><p>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.</p> </div>", "links"=>[], "tags"=>["tuberculosis", "hiv", "meta-analysis"], "article_id"=>139757, "categories"=>["Cancer", "Biotechnology"], "users"=>["Masja Straetemans", "Ana L. Bierrenbach", "Nico Nagelkerke", "Philippe Glaziou", "Marieke J. van der Werf"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0015241.s001", "https://dx.doi.org/10.1371/journal.pone.0015241.s002"], "stats"=>{"downloads"=>5, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/The_Effect_of_Tuberculosis_on_Mortality_in_HIV_Positive_People_A_Meta_Analysis/139757", "title"=>"The Effect of Tuberculosis on Mortality in HIV Positive People: A Meta-Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2010-12-30 02:42:37"}
  • {"files"=>["https://ndownloader.figshare.com/files/809379"], "description"=>"<p>Study ID on the Y-axis refers to first author and publication year; % weight refers to influence of each study on overall estimate (weights are from fixed effect analyses); for each study the central diamond indicates multivariate hazard ratio, line represents 95% confidence interval (CI), and the grey square reflects the study's weight in the pooling; overall estimate refers to pooled estimate of hazard ratio after mathematical combination of all studies; the X-axis indicates the scale and the direction of the effect of tuberculosis on mortality in HIV positive individuals.</p>", "links"=>[], "tags"=>["assessing", "tb", "hiv", "individuals", "haart", "cohort", "reported"], "article_id"=>479739, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Masja Straetemans", "Ana L. Bierrenbach", "Nico Nagelkerke", "Philippe Glaziou", "Marieke J. van der Werf"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0015241.g005", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Studies_assessing_the_effect_of_8220_prevalent_8221_8220_incident_8221_and_8220_prevalent_8221_8220_incident_8221_TB_on_all_cause_mortality_in_HIV_positive_individuals_before_HAART_era_lt_1996_or_8804_10_of_cohort_has_reported_use_of_HAART_/479739", "title"=>"Studies assessing the effect of “prevalent”, “incident” and “prevalent”+“incident” TB on all cause mortality in HIV positive individuals before HAART era (<1996) or ≤10% of cohort has reported use of HAART.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-12-30 02:42:19"}
  • {"files"=>["https://ndownloader.figshare.com/files/809463"], "description"=>"<p>Study ID on the Y-axis refers to first author and publication year; % weight refers to influence of each study on overall estimate (weights are from fixed effect analyses); for each study the central diamond indicates multivariate hazard ratio, line represents 95% confidence interval (CI), and the grey square reflects the study's weight in the pooling; overall estimate refers to pooled estimate of hazard ratio after mathematical combination of all studies; the X-axis indicates the scale and the direction of the effect of tuberculosis on mortality in HIV positive individuals.</p>", "links"=>[], "tags"=>["assessing", "tb", "hiv", "individuals", "haart", "cohort", "reported"], "article_id"=>479821, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Masja Straetemans", "Ana L. Bierrenbach", "Nico Nagelkerke", "Philippe Glaziou", "Marieke J. van der Werf"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0015241.g006", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Studies_assessing_the_effect_of_8220_prevalent_8221_8220_incident_8221_and_8220_prevalent_8221_8220_incident_8221_TB_on_all_cause_mortality_in_HIV_positive_individuals_during_HAART_era_and_8805_50_of_cohort_has_reported_use_of_HAART_/479821", "title"=>"Studies assessing the effect of “prevalent”, “incident” and “prevalent”+“incident” TB on all cause mortality in HIV positive individuals during HAART era and ≥50% of cohort has reported use of HAART.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-12-30 02:43:41"}
  • {"files"=>["https://ndownloader.figshare.com/files/809224"], "description"=>"<p>Study ID on the Y-axis refers to first author and publication year; % weight refers to influence of each study on overall estimate (weights are from random effect analyses); for each study the central diamond indicates multivariate hazard ratio, line represents 95% confidence interval (CI), and the grey square reflects the study's weight in the pooling; overall estimate refers to pooled estimate of hazard ratio after mathematical combination of all studies; the X-axis indicates the scale and the direction of the effect of tuberculosis on mortality in HIV positive individuals. I-squared denotes the extent of heterogeneity in study outcomes, with a (hypothetical) value of 100% meaning considerable heterogeneity and 0% meaning no heterogeneity between studies.</p>", "links"=>[], "tags"=>["assessing", "tb", "hiv"], "article_id"=>479591, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Masja Straetemans", "Ana L. Bierrenbach", "Nico Nagelkerke", "Philippe Glaziou", "Marieke J. van der Werf"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0015241.g003", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Studies_assessing_the_effect_of_8220_prevalent_8221_8220_incident_8221_and_8220_prevalent_8221_8220_incident_8221_TB_on_AIDS_related_all_cause_mortality_in_HIV_positive_individuals_/479591", "title"=>"Studies assessing the effect of “prevalent”, “incident” and “prevalent”+“incident” TB on AIDS-related/all cause mortality in HIV positive individuals.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-12-30 02:39:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/808973"], "description"=>"<p>Flow diagram of papers accepted and rejected during selection procedure.</p>", "links"=>[], "tags"=>["diagram", "papers", "accepted", "rejected"], "article_id"=>479336, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Masja Straetemans", "Ana L. Bierrenbach", "Nico Nagelkerke", "Philippe Glaziou", "Marieke J. van der Werf"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0015241.g001", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flow_diagram_of_papers_accepted_and_rejected_during_selection_procedure_/479336", "title"=>"Flow diagram of papers accepted and rejected during selection procedure.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-12-30 02:35:36"}
  • {"files"=>["https://ndownloader.figshare.com/files/809315"], "description"=>"<p>Study ID on the Y-axis refers to first author and publication year; % weight refers to influence of each study on overall estimate (weights are from random effect analyses); for each study the central diamond indicates multivariate hazard ratio, line represents 95% confidence interval (CI), and the grey square reflects the study's weight in the pooling; overall estimate refers to pooled estimate of hazard ratio after mathematical combination of all studies; the X-axis indicates the scale and the direction of the effect of tuberculosis on mortality in HIV positive individuals.</p>", "links"=>[], "tags"=>["assessing", "tb", "hiv", "individuals", "baseline", "cd4"], "article_id"=>479673, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Masja Straetemans", "Ana L. Bierrenbach", "Nico Nagelkerke", "Philippe Glaziou", "Marieke J. van der Werf"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0015241.g004", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Studies_assessing_the_effect_of_8220_prevalent_8221_8220_incident_8221_and_8220_prevalent_8221_8220_incident_8221_TB_on_all_cause_mortality_in_HIV_positive_individuals_with_baseline_CD4_cell_count_8804_200_cells_181_L_/479673", "title"=>"Studies assessing the effect of “prevalent”, “incident” and “prevalent”+“incident” TB on all cause mortality in HIV positive individuals with baseline CD4 cell count ≤200 cells/µL.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-12-30 02:41:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/809115"], "description"=>"<p>Points indicate log hazard ratios (x-axis) from 15 studies (contributing to 18 separate hazard ratio's) assessing the effect of “prevalent”, “incident”, and “prevalent+incident” TB on AIDS-related/all cause mortality in HIV positive individuals. Precision is calculated as 1/standard error. A lower precision indicates a more accurate estimate.</p>", "links"=>[], "tags"=>["15", "studies", "estimating", "tuberculosis", "aids-related"], "article_id"=>479479, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Masja Straetemans", "Ana L. Bierrenbach", "Nico Nagelkerke", "Philippe Glaziou", "Marieke J. van der Werf"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0015241.g002", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Funnelplot_of_15_studies_estimating_the_effect_of_tuberculosis_on_either_all_cause_mortality_or_AIDS_related_mortality_in_people_living_with_HIV_/479479", "title"=>"Funnelplot of 15 studies estimating the effect of tuberculosis on either all cause mortality or AIDS-related mortality in people living with HIV.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-12-30 02:37:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/809558"], "description"=>"<p>*The weights are from the random effect analyses if p<0.05 and the weights are from the fixed analyses if p≥0.05;</p>†<p>The HR indicates the effect of TB on all cause/AIDS related mortality because López Gattell, et al (2008) <sup>11</sup> reports the effect of TB on AIDS-related mortality;</p>‡<p>For both studies the multivariate hazard ratios as assessed by the marginal structural Cox proportional hazard have been included;</p>§<p>Analyses number 2.1 formed the basis for the sensitivity analyses.</p>", "links"=>[], "tags"=>["multivariate", "ratios", "subgroups", "studies", "estimating", "tb", "hiv"], "article_id"=>479917, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Masja Straetemans", "Ana L. Bierrenbach", "Nico Nagelkerke", "Philippe Glaziou", "Marieke J. van der Werf"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0015241.t001", "stats"=>{"downloads"=>4, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Pooled_multivariate_hazard_ratios_among_subgroups_of_studies_estimating_the_effect_of_TB_on_all_cause_mortality_in_HIV_positive_individuals_/479917", "title"=>"Pooled multivariate hazard ratios among subgroups of studies estimating the effect of TB on all cause mortality in HIV positive individuals.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-12-30 02:45:17"}

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