Unit Research, KNCV Tuberculosis Foundation, The Hague, The Netherlands.
PLoS One. 2010 Dec 30;5(12):e15241. doi: 10.1371/journal.pone.0015241.
Tuberculosis is a leading cause of death in people living with HIV (PLWH). We conducted a meta analysis to assess the effect of tuberculosis on mortality in people living with HIV.
Meta-analysis of cohort studies assessing the effect of tuberculosis on mortality in PLWH. To identify eligible studies we systematically searched electronic databases (until December 2008), performed manual searches of citations from relevant articles, and reviewed conference proceedings. Multivariate hazard ratios (HR) of mortality in PLWH with and without tuberculosis, estimated in individual cohort studies, were pooled using random effect weighting according to "Der Simonian Laird method" if the p-value of the heterogeneity test was <0.05.
Fifteen cohort studies were systematically retrieved. Pooled overall analysis of these 15 studies estimating the effect of tuberculosis on mortality in PLWH showed a Hazard Ratio (HR) of 1.8 (95% confidence interval (CI): 1.4-2.3). Subanalysis of 8 studies in which the cohort was not exposed to highly active antiretroviral therapy (HAART) showed an HR of 2.6 (95% CI: 1.8-3.6). Subanalysis of 6 studies showed that tuberculosis did not show an effect on mortality in PLWH exposed to HAART: HR 1.1 (95% CI: 0.9-1.3).
These results provide an indication of the magnitude of benefit to an individual that could have been expected if tuberculosis had been prevented. It emphasizes the need for additional studies assessing the effect of preventing tuberculosis or early diagnosis and treatment of tuberculosis in PLWH on reducing mortality. Furthermore, the results of the subgroup analyses in cohorts largely exposed to HAART provide additional support to WHO's revised guidelines, which include promoting the initiation of HAART for PLWH co-infected with tuberculosis. The causal effect of tuberculosis on mortality in PLWH exposed to HAART needs to be further evaluated once the results of more cohort studies become available.
结核病是导致艾滋病毒感染者（PLWH）死亡的主要原因。我们进行了一项荟萃分析，以评估结核病对 PLWH 死亡率的影响。
对评估结核病对 PLWH 死亡率影响的队列研究进行荟萃分析。为了确定合格的研究，我们系统地搜索了电子数据库（截至 2008 年 12 月），手动搜索了相关文章的参考文献，并审查了会议记录。如果异质性检验的 p 值<0.05，则使用“德西蒙尼-莱尔德方法”对个体队列研究中估计的结核病对 PLWH 死亡率的多变量危险比（HR）进行随机效应加权合并。
系统检索到 15 项队列研究。对这 15 项研究的综合分析表明，结核病对 PLWH 死亡率的影响的合并危险比（HR）为 1.8（95%置信区间（CI）：1.4-2.3）。在未接受高效抗逆转录病毒治疗（HAART）的 8 项研究的亚分析中，HR 为 2.6（95%CI：1.8-3.6）。在 6 项研究的亚分析中，结核病对接受 HAART 的 PLWH 的死亡率没有影响：HR 为 1.1（95%CI：0.9-1.3）。
这些结果表明，如果预防结核病，个体可能会预期获得的受益程度。它强调了需要开展更多的研究，评估预防结核病或早期诊断和治疗结核病对降低 PLWH 死亡率的影响。此外，在很大程度上接受 HAART 治疗的队列研究的亚组分析结果为世卫组织修订的指南提供了额外的支持，该指南包括促进对合并结核分枝杆菌感染的 PLWH 启动 HAART。一旦更多的队列研究结果可用，就需要进一步评估结核病对接受 HAART 的 PLWH 死亡率的因果效应。
