Abstract
BackgroundMultidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) and human immunodeficiency virus (HIV) co-infection are a deadly combination. While evidence on the effects of HIV co-infection on MDR/RR-TB treatment outcomes is well-documented, little published evidence describes the effects of MDR/RR-TB treatment on HIV disease.MethodsWe conducted a review of literature published prior to June 2020. We searched Pubmed, CINAHL, and EMBASE using variations of the terms “multidrug-resistant tuberculosis,” “HIV,” and either “CD4” or “viral load.” Two reviewers independently completed title and abstract screening, full-text screening, article evaluation, and data extraction. We also included five published articles evaluated as evidence by the World Health Organization (WHO) in preparation for the 2019 MDR/RR-TB treatment guideline update.ResultsA total of 459 references were returned, with 362 remaining after duplicate removal. Following article screening, six manuscripts were included. Articles reported CD4 count and/or viral load results for MDR/RR-TB and HIV co-infected patients during and/or after MDR/RR-TB treatment. The additional five references identified from the WHO guideline revision did not report HIV disease indicators after MDR/RR-TB initiation.ConclusionThere is a paucity of evidence on HIV disease indicators following MDR/RR-TB treatment. Researchers should report longitudinal HIV disease indicators in co-infected patients in publications.
Highlights
Tuberculosis (TB) is the world’s deadliest infectious disease and the leading cause of death for people living with human immunodeficiency virus (HIV) [1]
The additional five references identified from the World Health Organization (WHO) guideline revision did not report HIV disease indicators after MDR/RR-TB initiation
Due to potential for weakened immunity, people living with HIV and AIDS (PLWHA) are more likely to progress from latent infection to active disease following exposure to TB or MDR/RR-TB [1]
Summary
Tuberculosis (TB) is the world’s deadliest infectious disease and the leading cause of death for people living with human immunodeficiency virus (HIV) [1]. WHO MDR/RR-TB treatment guidelines encourage switching antiretroviral treatment (ART) regimens rather than modifying MDR/RR-TB medication choice or dosage, yet these guidelines do not specify which ART regimen should be used during MDR/RR-TB treatment, and individual countrylevel guidelines often leave this choice to a treating clinician [4]. This situation is one of several reasons the WHO recommends integration of MDR/RR-TB and HIV services to streamline care delivery and improve outcomes for co-infected patients [5]. Multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) and human immunodeficiency virus (HIV) co-infection are a deadly combination. While evidence on the effects of HIV co-infection on MDR/RR-TB treatment outcomes is well-documented, little published evidence describes the effects of MDR/RR-TB treatment on HIV disease
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