HIV infection and multidrug resistant tuberculosis: a systematic review and meta-analysis

Abstract

Background Multidrug-resistant tuberculosis (MDR-TB) in HIV infected individuals is a serious threat to global efforts to combat tuberculosis. Inconsistent findings on the association between HIV infection and MDR-TB were present in many studies. We aimed to review existing data on the relationship between HIV infection and MDR-TB systematically to assess the contribution of HIV on MDR-TB worldwide. We also investigated the patterns of MDR-TB by age, country-wise income, study designs, and global regions. Methods We utilized PubMed, Google Scholar, and ScienceDirect databases to select eligible studies for meta-analysis that were published between January 1, 2010, and July 30, 2020. The random-effects model was used to obtain the pooled odds ratio of the crude association between HIV and MDR-TB with a 95% confidence interval. We investigated the potential publication-bias by checking funnel plot asymmetry and using the Egger’s test. Moreover, we assessed the heterogeneity using the I2 statistic. Sensitivity analysis was performed based on sample size and adjustment factors. The protocol was registered with PROSPERO-CRD42019132752. Results We identified 1603 studies through a database search, and after subsequent eliminations we selected 54 studies including 430,534 TB patients. The pooled odds of MDR-TB was 1.42 times higher in HIV-positive patients than HIV-negative patients (OR=1.42,CI=1.17–1.71, I2=75.8%). Subgroup analysis revealed that the estimated pooled odds for South-East Asian countries was 1.86, which is the highest in WHO regions (OR=1.86,CI=1.30–2.67, I2=0.00%), followed by Europe and Africa. The effect estimate was found to be higher for primary MDR-TB (OR=2.76,CI=1.70–4.46, I2=0.00%). There was also a trend towards increased odds of MDR-TB for HIV patients older than 40 years (OR=1.56,CI=1.17–2.06). The association was found to be significant in high-burden TB countries (OR=1.75, CI=1.39–2.19) and in high-income countries (OR=1.55, CI=1.06–2.27). Conclusion Such findings indicate that HIV infection raises the risk of MDR-TB, and after contrasting it with the results of the earlier pooled study, it appeared to be an upward risk trend. Moreover, we found that the risk is the highest in the South-East Asian region. A balanced allocation of resources is needed to halt both primary and secondary MDR-TB, particularly in HIV infected people with 40 years of age and older.

High mortality among patients hospitalized for drug‐resistant tuberculosis with acquired second‐line drug resistance and high HIV prevalence

“…HIV infection appears to increase the risk of DR‐TB, although findings are inconsistent. A meta‐analysis of HIV infection and multidrug‐resistant tuberculosis (MDR‐TB; Mycobacterium tuberculosis with resistance to at least isoniazid and rifampicin) found the pooled odds ratio (OR) of MDR‐TB was 1.42‐fold higher in HIV‐positive than in HIV‐negative TB patients [95% confidence interval (CI): 1.17–1.71] 2 . Additionally, HIV infection increases the risk of developing adverse events in DR‐TB patients 3 .…”

Dynamics of Mycobacterium tuberculosis Lineages in Oman, 2009 to 2018

“…The large foreign communities, the majority of whom are from high-TB burden countries, can sustain latent TB reservoirs [ 17 ]. Dhofar and Muscat regions are also considered to have a high burden of multidrug-resistant TB (MDR-TB), defined as resistance to at least rifampicin (RIF) and isoniazid (INH) [ 18 ]. MDR strains have been linked to direct household transmission and clusters of recent transmission [ 19 ].…”

Status of drug resistant tuberculosis among patients attending a tuberculosis unit of West Bengal

“…[ 1 ] A systematic review By Sultana et al . [ 28 ] published in 2021 indicates that HIV infection raises the risk of MDR-TB. The odds of MDR-TB among HIV-positive cases were 1.42 times higher, and this was statistically significant, and the pooled odds of MDR-TB was 1.86 times higher for HIV positives than HIV negative individuals (OR = 1.86, 95% CI = 1.30–2.67) in the South-East Asian countries.…”