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

Abstract

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.

Active tuberculosis incidence among treatment failure experienced patients in North Wollow Zone: A multicenter historical cohort

“…The final report of this research indicated treatment failure experienced PLHIV who did not receive isoniazid preventive therapy (IPT) had a significant risk of active TB incidence after treatment failure experienced (AHR: 13.225, 95% CI: 2.894–60.434, p = 0.001). This is consistent with previous meta‐analysis findings in Ethiopia 15 , 18 and supported with premier studies. 38 , 39 , 40 This might be related to the concomitant IPT with ART administration reducing or demoted new cases of TB incidence and associated deaths by over 90% for PLHIV.…”

“… 38 , 39 , 40 This might be related to the concomitant IPT with ART administration reducing or demoted new cases of TB incidence and associated deaths by over 90% for PLHIV. 15 However, factors like IRIS, inadequate active TB screening by a caregiver, low IPT completion of PLHIV, and poor comprehensive care during successive follow‐up shifts end positive outcomes.…”

“…The twin epidemic of TB and HIV caused 0.3 million deaths worldwide in 2017, with a lifetime risk increase from 15% to 22% (1). TB‐associated case mortality accounts for 25%–40% of global deaths and 18%–25% of admissions among PLHIV, despite treatment and detection advances 13–15 …”

“…TB‐associated case mortality accounts for 25%–40% of global deaths and 18%–25% of admissions among PLHIV, despite treatment and detection advances. 13 , 14 , 15 …”

Advances in Antiretroviral Therapy for Patients with Human Immunodeficiency Virus-Associated Tuberculosis

“…Another study from the UK also showed that having a country of birth with a high tuberculosis burden was a significant risk factor for developing active HIV-related tuberculosis [ 18 ]. A meta-analysis among PLWH in Sub-Saharan Africa revealed that being underweight, having a low CD4 count, male gender, advanced WHO clinical stages, anemia, bedridden/ambulatory functional status, lack of isoniazid preventive therapy and lack of cotrimoxazole could boost the risk of tuberculosis occurrence [ 19 ].…”