Influence of HIV Co-infection on Tuberculosis Treatment Outcomes in Children: A Systematic Review and Meta-analysis of the Literature Público

Abstract

Introduction: Tuberculosis (TB) is an infectious disease that kills thousands of adults and children every year. Although treatment is available, effectiveness can be complicated by a range of factors such as co-infection with human immunodeficiency virus (HIV). When compared with adult TB patients who are not infected with HIV, co-infection with HIV has been shown to be associated with worse treatment outcomes. However, the influence of HIV on treatment outcomes in children has not yet been clearly established. This meta-analysis and systematic review was conducted in order to answer this question.

Methods: Search terms were developed and used in the databases PubMed, Embase and Cabi. Articles were retrieved and reviewed using predetermined inclusion and exclusion criteria. Both EndNote X7 and Covidence were used to sort articles for selection. Pertinent information was abstracted from the final included studies and reported in a Summary of Findings Table. 

Results: The literature search initially identified 896 articles. After review, 25 articles met the inclusion criteria and were selected for this review. A qualitative description of the articles was written and a meta-analysis performed. The summary risk ratio of all included studies for comparison of favorable treatment outcome rates was 0.775 (95% CI: 0.70- 0.86). When compared with children who had TB but no HIV infection, those with HIV infection were more likely to experience unfavorable treatment outcomes, with the resulting summary risk ratio found to be 1.77 (95% CI: 1.40- 2.24). Similarly, when comparing children who had TB but no HIV infection, those with HIV infection had significantly higher mortality; the summary risk ratio for comparison of death rates was 3.26 (95% CI: 2.57- 4.14). 

Conclusions: Children with TB disease and HIV co-infection are more likely to experience unfavorable treatment outcomes or die of TB than children without HIV co-infection. Additionally, children with TB disease and HIV co-infection were also less likely to experience favorable treatment outcomes. Future research should examine the influence of ART on treatment outcomes and whether this additional treatment for underlying HIV changes the observed findings.  

Table of Contents

Table of Contents

Introduction

Background Information..................................................................................................................1

Objectives........................................................................................................................................4

Methods

Literature Search..............................................................................................................................5

Data Analysis....................................................................................................................................7

Overview of the Available Literature................................................................................................8

Results

Qualitative Description of Studies....................................................................................................8

Meta-analysis for Favorable Treatment Outcomes..........................................................................17

Meta-analysis for Overall Mortality.................................................................................................17

Meta-analysis for Unfavorable Treatment Outcomes .....................................................................18

Discussion

Summary of Evidence......................................................................................................................18

Strengths and Weaknesses..............................................................................................................19

Conclusion......................................................................................................................................20

Future Directions............................................................................................................................20

References.......................................................................................................................................22

Tables and Figures...........................................................................................................................27

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	Tuberculosis
Committee Chair / Thesis Advisor	Kenneth G. Castro, Emory University

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