HIV: treating tuberculosis
INTRODUCTION: In people infected with both HIV and Mycobacterium tuberculosis, the annual risk of developing active tuberculosis is 5% to 10% — more than 10 times the rate for HIV-negative people with M tuberculosis infection. Untreated, mortality from tuberculosis in people with HIV is likely to be high, and over 5% of people relapse after successful treatment. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of first-line treatments for tuberculosis in HIV-positive people? What are the effects of second-line treatments for tuberculosis in HIV-positive people? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 23 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant immunotherapy (with corticosteroids, or Mycobacterium vaccae); antimycobacterial treatment combinations; conventional antituberculous treatment (short course, long course, including rifabutin [3 or 5 months], quinolones, or thiacetazone); directly observed therapy (short course); highly active antiretroviral treatment (early initiation or delayed initiation); rifampicin (3 months or less); secondary prophylaxis with antituberculous treatment; and unsupervised treatment.
Payne B and Bellamy R. HIV: treating tuberculosis. Clinical Evidence 2009; 11:920.
Substantive changes at this update
Early initiation of highly active antiretroviral treatment Two cohort studies added. One prospective study found mortality was increased the longer HAART initiation was delayed after starting antituberculosis treatment, and found decreased mortality in people with bacteriologically confirmed tuberculosis, who started HAART within the first 120 days of antituberculosis treatment versus people who started HAART later than this. Another study (retrospective from 1996 to 2000; prospective from 2000 to 2004) found better survival in people who started HAART within 2 months of starting antituberculous treatment versus people who started HAART more than 3 months after antituberculous treatment.Categorisation unchanged (unknown effectiveness).
Rated by doctors in Relevance Newsworthiness Internal Medicine ***** ***** Infectious Disease ***** **** Tropical and Travel Medicine ****** ***** Respirology/Pulmonology ****** ****** Public Health ****** ****
Rated by doctors in Relevance Newsworthiness Infectious Disease ***** ***** Tropical and Travel Medicine ***** ******