Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review

 

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dc.contributor.author Arentz, Matthew en_ZA
dc.contributor.author Pavlinac, Patricia en_ZA
dc.contributor.author Kimerling, Michael E en_ZA
dc.contributor.author Horne, David J en_ZA
dc.contributor.author Falzon, Dennis en_ZA
dc.contributor.author Schünemann, Holger J en_ZA
dc.contributor.author Royce, Sarah en_ZA
dc.contributor.author Dheda, Keertan en_ZA
dc.contributor.author Walson, Judd L en_ZA
dc.date.accessioned 2016-01-11T06:53:24Z
dc.date.available 2016-01-11T06:53:24Z
dc.date.issued 2012 en_ZA
dc.identifier.citation Arentz, M., Pavlinac, P., Kimerling, M. E., Horne, D. J., Falzon, D., Schünemann, H. J., ... & Walson, J. L. (2012). Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review. PLoS One, 7(11), e47370. doi:10.1371/journal.pone.0047370 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/16274
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0047370
dc.description.abstract Introduction: Use of antiretroviral therapy (ART) during treatment of drug susceptible tuberculosis (TB) improves survival. However, data from HIV infected individuals with drug resistant TB are lacking. Second line TB drugs when combined with ART may increase drug interactions and lead to higher rates of toxicity and greater noncompliance. This systematic review sought to determine the benefit of ART in the setting of second line drug therapy for drug resistant TB. Methods: We included individual patient data from studies that evaluated treatment of drug-resistant tuberculosis in HIV-1 infected individuals published between January 1980 and December of 2009. We evaluated the effect of ART on treatment outcomes, time to smear and culture conversion, and adverse events. Results: Ten observational studies, including data from 217 subjects, were analyzed. Patients using ART during TB treatment had increased likelihood of cure (hazard ratio (HR) 3.4, 95% CI 1.6–7.4) and decreased likelihood of death (HR 0.4, 95% CI 0.3–0.6) during treatment for drug resistant TB. These associations remained significant in patients with a CD4 less than 200 cells/mm3 and less than 50 cells/mm3, and when correcting for drug resistance pattern. Limitations: We identified only observational studies from which individual patient data could be drawn. Limitations in study design, and heterogeneity in a number of the outcomes of interest had the potential to introduce bias. Discussion: While there are insufficient data to determine if ART use increases adverse drug interactions when used with second line TB drugs, ART use during treatment of drug resistant TB appears to improve cure rates and decrease risk of death. All individuals with HIV appear to benefit from ART use during treatment for TB. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Tuberculosis en_ZA
dc.subject.other Antiretroviral therapy en_ZA
dc.subject.other Drug therapy en_ZA
dc.subject.other HIV infections en_ZA
dc.subject.other Adverse events en_ZA
dc.subject.other Extensively drug-resistant tuberculosis en_ZA
dc.subject.other HIV en_ZA
dc.subject.other Drug interactions en_ZA
dc.title Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2012 Arentz et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Institute of Infectious Disease and Molecular Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.