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Tuberculosis (TB) is the leading cause of morbidity and mortality in HIV-infected patients and accounts for approximately half of all AIDS-related deaths in sub-Saharan Africa. Recent evidence indicates that the incidence of HIV-associated TB can be substantially reduced through scale-up of antiretroviral therapy (ART). Now, a systematic review and meta-analysis support these findings.
The analysis included 11 studies, all of which were conducted in developing countries and in which researchers reported the incidence of TB according to ART status in HIV-infected individuals (age, ≥13 years) with at least 6 months of follow-up.
Overall, ART was found to reduce TB incidence by 65% (hazard ratio, 0.35). The effect appeared to be greatest in patients who had the lowest CD4-cell counts at ART initiation, although the difference was not statistically significant; the hazard ratio was 0.16 in patients with baseline CD4 counts <200 cells/mm3, 0.34 in patients with baseline CD4 counts ranging from 200 to 350 cells/mm3, and 0.43 in those with CD4 counts >350 cells/mm3.
Suthar AB et al. Antiretroviral therapy for prevention of tuberculosis in adults with HIV: A systematic review and meta-analysis. PLoS Med 2012 Jul 24; 9:e1001270. (http://dx.doi.org/10.1371/journal.pmed.1001270)
Comment
This meta-analysis supports the conclusion that ART reduces the risk for TB across all CD4 cell–count levels in various study populations. The finding that ART initiation at CD4 counts >350 cells/mm3 reduces TB incidence should be factored into the decision about whether to start ART early, especially in developing countries where TB is the leading cause of morbidity and mortality in HIV-infected people.