Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

García, Juan Ignacio; Mambuque, Edson; Nguenha, Dinis; Vilanculo, Faustino; Sacoor, Charfudin; Sequera, Víctor Guillermo; Fernández-Quevedo, Manuel; Pierre, Maxime Leroux-La; Chiconela, Helio; Faife, Luis A.; Respeito, Durval; Saavedra, Belén; Nhampossa, Tacilta; López-Varela, Elisa; García‐Basteiro, Alberto L.

doi:10.1038/s41598-020-71784-3

Cited by 17 publications

(10 citation statements)

References 42 publications

(47 reference statements)

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“… 8 Adults 2383 7736.8 70 0.905 42. East Africa García JI, et al [ 101 ], 2020 Mozambique Retr. 2 Both 382 685.2 37 5.4 43.…”

Section: Resultsmentioning

confidence: 99%

The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis

Wondmeneh,

Mekonnen

2023

BMC Infect Dis

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Background Tuberculosis, along with HIV, is the leading cause of mortality and morbidity globally. Despite the fact that several primary studies have been conducted on the incidence rate of tuberculosis in HIV-infected people in Sub-Saharan Africa, the regional-level tuberculosis incidence rate remains unknown. The objective of this study is to determine the tuberculosis incidence rate and its associated factors in HIV-infected people in Sub-Saharan Africa. Methods A systematic review and meta-analysis were conducted by searching four databases for studies published in English between January 1, 2000, and November 25, 2022. The study was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. To assess the quality of the studies, the Joanna Briggs Institute critical appraisal checklist was used. A random-effects model meta-analysis was used to determine the pooled incidence of tuberculosis using STATA version 15. The I2 heterogeneity test was used to assess heterogeneity. Subgroup and sensitivity analyses were performed. Funnel plots and Egger’s regression tests were used to investigate publication bias. The pooled estimate predictors of tuberculosis incidence rate with a 95% confidence interval were also determined using the hazard ratio of each factor (HR). Results Out of a total of 3339 studies, 43 were included in the analysis. The overall pooled incidence rate of tuberculosis in HIV-infected people was 3.49 per 100 person-years (95% CI: 2.88–4.17). In the subgroup analysis, the pooled incidence rate of tuberculosis in HIV-infected children was 3.42 per 100 person-years (95% CI: 1.78, 5.57), and it was 3.79 per 100 person-years (95% CI: 2.63, 5.15) in adults. A meta-analysis revealed that underweight (AHR = 1.79, 95% CI: 1.61–1.96), low CD4 count (AHR = 1.23, 95% CI: 1.13–1.35), male gender (AHR = 1.43, 95% CI: 1.22–1.64), advanced WHO clinical stages (AHR = 2.29, 95% CI: 1.34–3.23), anemia (AHR = 1.73, 95% CI: 1.34–2.13), bedridden or ambulatory (AHR = 1.87, 95%), lack of isoniazid preventive therapy (AHR = 3.32, 95% CI: 1.08–2.28), and lack of cotrimoxazole (AHR = 1.68, 95% CI: 1.08–2.28) were risk factors for tuberculosis incidence. HIV patients who received antiretroviral therapy had a 0.53 times higher risk of acquiring tuberculosis than HIV patients who did not receive antiretroviral therapy (AHR = 0.53; 95% CI: 0.3–0.77). Conclusion In this systematic review and meta-analysis study, the incidence rate of tuberculosis among HIV-positive people was higher than the WHO 2022 Africa regional estimated report. To reduce the incidence of tuberculosis among HIV patients, HIV patients should take isoniazid prevention therapy (IPT), cotrimoxazole prophylaxis, and antiretroviral therapy (ART) without interruption, as well as increase the frequency and diversity of their nutritional intake. Active tuberculosis screening should be increased among HIV-infected people.

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“… 8 Adults 2383 7736.8 70 0.905 42. East Africa García JI, et al [ 101 ], 2020 Mozambique Retr. 2 Both 382 685.2 37 5.4 43.…”

Section: Resultsmentioning

confidence: 99%

The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis

Wondmeneh,

Mekonnen

2023

BMC Infect Dis

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“…9 Our results showed that HIV patients never tested for LTBI and those who tested positive at the first instance were at higher risk of TB disease development. 10…”

Section: Discussionmentioning

confidence: 99%

A retrospective longitudinal study on tuberculosis disease among people with HIV

Tuppekar

Mutyepod²,

Kumbar³

2022

PJMS

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The use of Isoniazid Prevention Therapy (IPT) helps normalize the health issues of patients with TB. The majority of patients suffering from these diseases are from a low-income group with poor education. They do not have adequate knowledge related to prevention and approaches that reduce the occurrence of TB disease soon after ART initiation where risk is higher. The study aims to determine the incidence of tuberculosis disease among patients with HIV while taking IPT and after its completion. This is a retrospective, observational, longitudinal study that used existing records of patients from Department of Pulmonary Medicine, D Y Patil Medical College, Nerul, Navimumbai, Maharashtra, India. The period of the study was from January 2020 to June 2021. STATA statistical software Version 12 was used to analyse the data. The sample size was estimated based on simple proportion formula taking incident TB disease after starting IPT 1.5% based on the study in a similar setting. In this study, 960 patients were involved with mean age of 30 years, ranged between 25-37 years. TB was developed in 9.2% patients, out of which, 2.2% of patients were diagnosed while receiving IPT and 6.97% after IPT. Moreover, 55.2% of patients were on this treatment at the last observation. The unfavourable count of patients was 152 (15.8%). Most of the patients with unfavourable follow-up outcomes were lost to follow-up. 0.6% of patients have stopped treatment during the follow-up and 28.9% was transferred out. Finally, 4.7% of patients died and remaining were recovered. Breakthrough TB was uncommon and shown a significant proportion of it occurrence in the first month of treatment. This could be due to difficulty in diagnosing TB disease with HIV. The proper screening of patients is essential for offering treatment and providing effective care services.

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“…Some patients with respiratory symptoms may have received antibiotic treatment (with drugs other than for TB) prior to TB diagnosis and, although this is relatively rare in our setting, we did not collect these data in all presumptive TB patients. An improved understanding of the underlying causes of the spectrum of disease in SCs is especially important to not only the TB field in general [55,56] but especially for microbiome research. Lastly, our objective was to comprehensively characterise the microbiome pretreatment (before the confounding effects of antibiotics), however, future research on the long-term effects of TB treatment on the microbiome is important, including its link with recurrence.…”

Section: Discussionmentioning

confidence: 99%

Anaerobe-enriched gut microbiota predicts pro-inflammatory responses in pulmonary tuberculosis

Naidoo

Nyawo

et al. 2021

EBioMedicine

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Background: The relationship between tuberculosis (TB), one of the leading infectious causes of death worldwide, and the microbiome, which is critical for health, is poorly understood. Methods: To identify potential microbiome-host interactions, profiling of the oral, sputum and stool microbiota [n = 58 cases, n = 47 culture-negative symptomatic controls (SCs)] and whole blood transcriptome were done in pre-treatment presumptive pulmonary TB patients. This was a cross-sectional study. Microbiota were also characterised in close contacts of cases (CCCs, n = 73) and close contacts of SCs (CCSCs, n = 82) without active TB.Findings: Cases and SCs each had similar aand b-diversities in oral washes and sputum, however, b-diversity differed in stool (PERMANOVA p = 0035). Cases were enriched with anaerobes in oral washes, sputum (Paludibacter, Lautropia in both) and stool (Erysipelotrichaceae, Blautia, Anaerostipes) and their stools enriched in microbial genes annotated as amino acid and carbohydrate metabolic pathways. In pairwise comparisons with their CCCs, cases had Megasphaera-enriched oral and sputum microbiota and Bifidobacterium-, Roseburia-, and Dorea-depleted stools. Compared to their CCSCs, SCs had reduced a-diversities and many differential taxa per specimen type. Cases differed transcriptionally from SCs in peripheral blood (PERMANOVA p = 0001). A co-occurrence network analysis showed stool taxa, Erysipelotrichaceae and Blautia, to negatively co-correlate with enriched "death receptor" and "EIF2 signalling" pathways whereas Anaerostipes positively correlated with enriched "interferon signalling", "Nur77 signalling" and "inflammasome" pathways; all of which are host pathways associated with disease severity. In contrast, none of the taxa enriched in SCs correlated with host pathways. Interpretation: TB-specific microbial relationships were identified in oral washes, induced sputum, and stool from cases before the confounding effects of antibiotics. Specific anaerobes in cases' stool predict upregulation of pro-inflammatory immunological pathways, supporting the gut microbiota's role in TB.

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Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

Cited by 17 publications

References 42 publications

The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis

The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis

A retrospective longitudinal study on tuberculosis disease among people with HIV

Anaerobe-enriched gut microbiota predicts pro-inflammatory responses in pulmonary tuberculosis

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