Incidence and predictors of tuberculosis among HIV patients after initiation of antiretroviral treatment in Ethiopia: a systematic review and meta-analysis

Melkalem Mamuye Azanaw,Gebeyehu Shumuye Yetemegn,Nebiyu Mekonnen Derseh,Dessie Abebaw Angaw

doi:10.1186/s41182-021-00306-2

Melkalem Mamuye Azanaw, Gebeyehu Shumuye Yetemegn + Show 2 more

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https://doi.org/10.1186/s41182-021-00306-2

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Abstract

BackgroundTuberculosis is the oldest infectious disease and it is still the leading cause of morbidity and mortality worldwide. Even though several primary studies have been conducted on the incidence of tuberculosis among HIV-infected individuals in Ethiopia, national-level tuberculosis incidence is unknown. Therefore, this study is aimed to assess the TB incidence rate and its predictors among HIV-infected individuals after the initiation of ART in Ethiopia.MethodsWe conducted an extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). The databases used were PubMed, Google Scholar, and HINARI literature. We used the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument for critical appraisal of studies. The meta-analysis and Meta regressions were conducted using STATA 14 software. Met-analysis and meta-regression were computed to present the pooled incidence rate and predictors of tuberculosis among HIV-infected patients after initiation of ART with a 95% confidence interval.ResultsAmong a total of 189 studies, 11 studies were included in this analysis. The estimated pooled incidence rate of TB per 100-person year observation (PYO) among HIV-infected patients after initiation of ART therapy was 4.8(95% CI 3.69–5.83). In subgroup analysis, the estimated pooled incidence of tuberculosis showed a slight difference between adults and children after initiation of ART treatment, which was 4.3 (95% CI 2.96, 5.71) and 5.0 (95% CI 3.51, 6.50), respectively. Significantly pooled estimates of predictors of TB incidence by a meta-analysis were being anemic (2.30, 95% CI 1.75, 3.02); on clinical stages III and IV (2.26, 95% CI 1.70, 3.02); and not on cotrimoxazole preventive therapy (CPT) (2.16, 95% CI 1.23, 3.72). Besides, a meta-regression revealed that CD4 <200 cells/mm3 (2.12, 95% CI 1.17, 3.86) was a positive significant predictor of TB among HIV patients after the initiation of ART.ConclusionsThe current study showed that the pooled incidence of TB among HIV patients was found to be lower than the WHO 2018 national estimate. Being anemic, WHO stages III and IV, not on CPT, CD4<200cells/μl, and being male were significant predictors of tuberculosis. Therefore, the existing strategies to decrease TB should be strengthening.Study protocol registrationCRD42020155573.

Highlights

Tuberculosis is the oldest infectious disease and it is still the leading cause of morbidity and mortality worldwide
The current study showed that the pooled incidence of TB among Human immunodeficiency virus (HIV) patients was found to be lower than the World Health Organization (WHO) 2018 national estimate
The current study revealed that the pooled TB incidence among HIV-infected patients after initiation of Antiretroviral treatment (ART) was 4.76 per 100 person year observation (PYO) which was in line with the primary studies done in India in 2019 and Tanzania in 2015 which were 4.39 cases and 4.4 cases per 100 PYO, respectively [27, 28]

Summary

Introduction

Tuberculosis is the oldest infectious disease and it is still the leading cause of morbidity and mortality worldwide. This study is aimed to assess the TB incidence rate and its predictors among HIV-infected individuals after the initiation of ART in Ethiopia. Human immunodeficiency virus-infected people are at the highest risk for developing TB of which 22 times more likely to be ill with TB than those without HIV. Human immunodeficiency virus infection is the main risk factor for active tuberculosis disease [2] and 10% higher rates of progression from latent to active TB that leads to more severe disseminated disease presentation and increased mortality. Despite the widespread use of ART with isoniazid preventive therapy (IPT), intensified case finding, and infection control as a whole the three WHOI’s strategy in Ethiopia, tuberculosis is the common cause of morbidity and mortality among HIV patients. According to the WHO global TB report, 2018, Ethiopia had an estimated 12000 incident TB per 100,000 population among HIV infected individuals [1]

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