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

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dc.contributor.authorArentz, Matthewen_ZA
dc.contributor.authorPavlinac, Patriciaen_ZA
dc.contributor.authorKimerling, Michael Een_ZA
dc.contributor.authorHorne, David Jen_ZA
dc.contributor.authorFalzon, Dennisen_ZA
dc.contributor.authorSchünemann, Holger Jen_ZA
dc.contributor.authorRoyce, Sarahen_ZA
dc.contributor.authorDheda, Keertanen_ZA
dc.contributor.authorWalson, Judd Len_ZA
dc.date.accessioned2016-01-11T06:53:24Z
dc.date.available2016-01-11T06:53:24Z
dc.date.issued2012en_ZA
dc.description.abstractIntroduction: 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.identifier.apacitationArentz, 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. <i>PLoS One</i>, http://hdl.handle.net/11427/16274en_ZA
dc.identifier.chicagocitationArentz, Matthew, Patricia Pavlinac, Michael E Kimerling, David J Horne, Dennis Falzon, Holger J Schünemann, Sarah Royce, Keertan Dheda, and Judd L Walson "Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review." <i>PLoS One</i> (2012) http://hdl.handle.net/11427/16274en_ZA
dc.identifier.citationArentz, 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.0047370en_ZA
dc.identifier.ris TY - Journal Article AU - Arentz, Matthew AU - Pavlinac, Patricia AU - Kimerling, Michael E AU - Horne, David J AU - Falzon, Dennis AU - Schünemann, Holger J AU - Royce, Sarah AU - Dheda, Keertan AU - Walson, Judd L AB - 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. DA - 2012 DB - OpenUCT DO - 10.1371/journal.pone.0047370 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review TI - Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review UR - http://hdl.handle.net/11427/16274 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16274
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0047370
dc.identifier.vancouvercitationArentz M, Pavlinac P, Kimerling ME, Horne DJ, Falzon D, Schünemann HJ, et al. Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review. PLoS One. 2012; http://hdl.handle.net/11427/16274.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2012 Arentz et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherDrug therapyen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherAdverse eventsen_ZA
dc.subject.otherExtensively drug-resistant tuberculosisen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherDrug interactionsen_ZA
dc.titleUse of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic reviewen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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