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Antiretroviral therapy for prevention of tuberculosis in adults with HIV: a systematic review and meta-analysis Full Text
PLoS Medicine, 08/09/2012
Clinical Article
Suthar AB et al. – Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis across all CD4 count strata. Earlier initiation of antiretroviral therapy may be a key component of global and national strategies to control the HIV–associated tuberculosis syndemic.
Methods- PubMed, Embase, African Index Medicus, LILACS, and clinical trial registries were systematically searched.
- Randomised controlled trials, prospective cohort studies, and retrospective cohort studies were included if they compared tuberculosis incidence by antiretroviral therapy status in HIV–infected adults for a median of over 6 mo in developing countries.
- For the meta–analyses there were four categories based on CD4 counts at antiretroviral therapy initiation:
- Less than 200 cells/ μl,
- 200 to 350 cells/μl,
- Greater than 350 cells/μl,
- And any CD4 count.
- Eleven studies met the inclusion criteria.
- Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis in all baseline CD4 count categories:
- Less than 200 cells/ μl (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.07 to 0.36),
- 200 to 350 cells/ μl (HR 0.34, 95% CI 0.19 to 0.60),
- Greater than 350 cells/ μl (HR 0.43, 95% CI 0.30 to 0.63),
- And (any CD4 count (HR 0.35, 95% CI 0.28 to 0.44).
- There was no evidence of hazard ratio modification with respect to baseline CD4 count category (p = 0.20).