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CD4 count and tuberculosis risk in HIV-positive adults not on ART: a systematic review and meta-analysis.

ABSTRACT: Background:CD4 cell count in adults with human immunodeficiency virus (HIV) infection (PLHIV) not receiving antiretroviral therapy (ART) influences tuberculosis (TB) risk. Despite widespread use in models informing resource allocation, this relationship has not been systematically reviewed. Methods:We systematically searched MEDLINE, Aidsinfo, Cochrane review database and Google Scholar for reports in English describing TB incidence stratified by updated CD4 cell count in cohorts of HIV-positive adults (age ?15 years) not on ART (PROSPERO protocol no: CRD42016048888). Among inclusion criteria were: reporting precision for TB incidence, repeated CD4 measurements, and TB incidence reported for those not on ART or monotherapy. Study quality was assessed via the Newcastle-Ottawa tool for cohort studies. A Bayesian hierarchical model was fitted to estimate the pooled factor increase in TB incidence with respect to CD4 cell count decrement. Results:A total of 1,555 distinct records were identified from which 164 full text articles were obtained. Common reasons for exclusion of full texts were: no valid TB incidence, no repeat CD4 measurements, and not reporting TB incidence by ART status. The seven studies included reported on 1,206 TB cases among 41,271 individuals, with a typical median follow-up of four years. Studies were generally rated as moderate or high quality. Our meta-analysis estimated a 1.43 (95% credible interval: 1.16-1.88)-fold increase in TB incidence per 100 cells per mm3 decrease in CD4 cell count. Discussion:Our analysis confirms previous estimates of exponential increase in TB incidence with declining CD4 cell count in adults, emphasizing the importance of early ART initiation to reduce TB risk in PLHIV.

SUBMITTER: Ellis PK

PROVIDER: S-EPMC5733368 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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CD4 count and tuberculosis risk in HIV-positive adults not on ART: a systematic review and meta-analysis.

Ellis Penelope K PK Martin Willam J WJ Dodd Peter J PJ

PeerJ 20171214

<h4>Background</h4>CD4 cell count in adults with human immunodeficiency virus (HIV) infection (PLHIV) not receiving antiretroviral therapy (ART) influences tuberculosis (TB) risk. Despite widespread use in models informing resource allocation, this relationship has not been systematically reviewed.<h4>Methods</h4>We systematically searched MEDLINE, Aidsinfo, Cochrane review database and Google Scholar for reports in English describing TB incidence stratified by updated CD4 cell count in cohorts ...[more]

PMID: 29259846

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Project description:BACKGROUND:Tuberculosis (TB) and HV have been intertwined and makeup a deadly human syndemic worldwide, especially in developing countries like Ethiopia. Previous studies have reported different TB incidences and its association with CD4+ T cell counts among HIV positive patients in Ethiopia. Thus, the goal of this meta-analysis was, first, to determine pooled incident TB among adult HIV positive patients, and second, to assess the association between incident TB and baseline CD4+ T cell count strata's. METHODS:We searched PubMed, Cochrane library, Science Direct and Google scholar databases from June 1 to 30, 2018. The I2 statistics and Egger's regression test was used to determine heterogeneity and publication bias among included studies respectively. A random effects model was used to estimate pooled incident TB and odds ratio with the respective 95% confidence intervals using Stata version 11.0 statistical software. RESULTS:A total of 403 research articles were identified, and 10 studies were included in the meta-analysis. The pooled incident TB among adult HIV infected patients in Ethiopia was 16.58% (95% CI; 13.25-19.91%). Specifically, TB incidence in Pre-ART and ART was 17.16% (95% CI; 7.95-26.37%) and 16.24% (95% CI; 12.63-19.84%) respectively. Moreover, incident TB among ART receiving patients with baseline CD4+ T cell count < and > 200 cells/mm3 was 28.86% (95% CI; 18.73-38.98%) and 13.7% (95% CI; 1.41-25.98%) correspondingly. The odds of getting incident TB was 2.88 (95% CI; 1.55-5.35%) for patients with baseline CD4+ T cell count <?200 cells/mm3 compared to patients with baseline CD4+ T cell count >?200 cells/mm3. CONCLUSION:High incident TB among adult HIV positive patients was estimated, especially in patients with CD4+ T cell count <?200 cells/mm3. Therefore, Early HIV screening and ART initiation, as well as strict compliance with ART and increasing the coverage of TB preventive therapy to more risky groups are important to prevent the problem. TRIAL REGISTRATION:Study protocol registration: CRD42018090802.

Project description:Human immunodeficiency virus (HIV) infection is the strongest risk factor for developing tuberculosis and has fuelled its resurgence, especially in sub-Saharan Africa. In 2010, there were an estimated 1.1 million incident cases of tuberculosis among the 34 million people living with HIV worldwide. Antiretroviral therapy has substantial potential to prevent HIV-associated tuberculosis. We conducted a systematic review of studies that analysed the impact of antiretroviral therapy on the incidence of tuberculosis in adults with HIV infection.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: (1) less than 200 cells/µl, (2) 200 to 350 cells/µl, (3) greater than 350 cells/µl, and (4) 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: (1) less than 200 cells/µl (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.07 to 0.36), (2) 200 to 350 cells/µl (HR 0.34, 95% CI 0.19 to 0.60), (3) greater than 350 cells/µl (HR 0.43, 95% CI 0.30 to 0.63), and (4) 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).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.International Prospective Register of Systematic Reviews CRD42011001209 Please see later in the article for the Editors' Summary.

Project description:IntroductionLate presentation to HIV/AIDS care which is attended by problems like, poor treatment outcomes, early development of opportunistic infections, increased healthcare costs, and mortality is a major problem in Ethiopia. Although evidences are available on the prevalence and associated factors of late presentation to HIV/AIDS care, discrepancies among findings are appreciated. Thus, the country has faced difficulties of having a single estimated data.ObjectiveThis study aimed to estimate the pooled prevalence of late presentation of HIV positive adults to HIV/AIDS care and its predictors in Ethiopia.MethodWe searched all available articles through Google Scholar, PubMed, Web of Sciences, and EMBASE databases. Additionally, we accessed articles from the Ethiopian institutional online research repositories and reference lists of included studies. We included cohort, case- control, and cross-sectional studies in our review. Besides, we utilized the weighted inverse variance random-effects model. The total percentage of variation among studies due to heterogeneity was determined by I2 statistic. Searching was limited to studies conducted in Ethiopia and published in the English language. Publication bias was checked by Egger's regression test.ResultsA total of 8 studies with 7, 568 participants were included. The pooled prevalence of late presentation to HIV/AIDS care was 52.89% (95%CI: 35.37, 70.40). The odds of late presentation to HIV/AIDS care of frequent alcohol users [3.67(95% CI?=?1.52-5.83)], high fear of stigma [3.90 (95% CI?=?1.51-6.28)], chronic illness [3.34(95% CI?=?1.52-5.16)], and the presence of symptoms at the time of HIV diagnosis [3.06 (95% CL?=?1.18-4.94)] were higher compared to participants who did not experience the preceding.ConclusionThe prevalence of late presentation of HIV positive adults to HIV/AIDS care was high in Ethiopia. Frequent alcohol use, high fear of stigma, chronic illness, and the presence of symptoms at the time of HIV diagnosis were associated with high odds of late presentation to HIV/AIDS care.Trial registrationRegistered in PROSPERO databases with the registration number of CRD42018081840 .

Project description:BackgroundCD4 cell count is an important test in HIV programs for baseline risk assessment, monitoring of ART where viral load is not available, and, in many settings, antiretroviral therapy (ART) initiation decisions. However, access to CD4 testing is limited, in part due to the centralized conventional laboratory network. Point of care (POC) CD4 testing has the potential to address some of the challenges of centralized CD4 testing and delays in delivery of timely testing and ART initiation. We conducted a systematic review and meta-analysis to identify the extent to which POC improves linkages to HIV care and timeliness of ART initiation.MethodsWe searched two databases and four conference sites between January 2005 and April 2015 for studies reporting test turnaround times, proportion of results returned, and retention associated with the use of point-of-care CD4. Random effects models were used to estimate pooled risk ratios, pooled proportions, and 95% confidence intervals.ResultsWe identified 30 eligible studies, most of which were completed in Africa. Test turnaround times were reduced with the use of POC CD4. The time from HIV diagnosis to CD4 test was reduced from 10.5 days with conventional laboratory-based testing to 0.1 days with POC CD4 testing. Retention along several steps of the treatment initiation cascade was significantly higher with POC CD4 testing, notably from HIV testing to CD4 testing, receipt of results, and pre-CD4 test retention (all p<0.001). Furthermore, retention between CD4 testing and ART initiation increased with POC CD4 testing compared to conventional laboratory-based testing (p = 0.01). We also carried out a non-systematic review of the literature observing that POC CD4 increased the projected life expectancy, was cost-effective, and acceptable.ConclusionsPOC CD4 technologies reduce the time and increase patient retention along the testing and treatment cascade compared to conventional laboratory-based testing. POC CD4 is, therefore, a useful tool to perform CD4 testing and expedite result delivery.

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CD4 count and tuberculosis risk in HIV-positive adults not on ART: a systematic review and meta-analysis.

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CD4 count and tuberculosis risk in HIV-positive adults not on ART: a systematic review and meta-analysis.

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