From the University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV co-infection and for TB elimination, University of Brescia, Brescia, Italy.
Unit of Public Health, Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Parma, Italy.
Pediatr Infect Dis J. 2018 May;37(5):e117-e125. doi: 10.1097/INF.0000000000001784.
Tuberculosis (TB) is the major cause of mortality in HIV-infected children globally. Current guidelines about the management of antiretroviral therapy in children with TB are based on a limited number of nonrandomized studies involving small numbers of participants. The aim of the study was to systematically retrieve and critically appraise available evidence on the efficacy and safety of different antiretroviral regimens in children with HIV infection who are receiving treatment for active TB.
We conducted a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Records were retrieved through March 2016 from Medline, Embase and manual screening of key conference proceedings. Four specific research questions assessing available treatment options were defined.
Although 4 independent searches were conducted (1 for each Population, Intervention, Comparator, Outcomes question), results were elaborated and interpreted together because of significant overlap among the retrieved records. Six observational studies were selected for qualitative synthesis while meta-analysis could not be performed.
Evidence for optimal treatment options for HIV/TB coinfected children is limited. As the global community strives to reach the fast-track HIV treatment targets and eliminate childhood TB deaths, it must ensure that coinfected children are included in key treatment studies and expand this neglected but crucial area of research.
结核病（TB）是全球 HIV 感染儿童死亡的主要原因。目前关于 HIV 感染合并结核病儿童抗逆转录病毒治疗管理的指南，是基于少数非随机研究，这些研究涉及的参与者数量较少。本研究旨在系统检索和批判性评估现有证据，评估不同抗逆转录病毒方案治疗正在接受活动性结核病治疗的 HIV 感染儿童的疗效和安全性。
我们根据系统评价和荟萃分析的首选报告项目指南进行了系统文献回顾。通过 2016 年 3 月在 Medline、Embase 以及关键会议论文集的手动筛查，检索了记录。确定了 4 个特定的研究问题，评估了现有的治疗选择。
尽管进行了 4 项独立的检索（1 项针对每个人群、干预措施、比较、结局问题），但由于检索记录之间存在显著重叠，因此对结果进行了阐述和解释。选择了 6 项观察性研究进行定性综合，而无法进行荟萃分析。
针对 HIV/TB 合并感染儿童的最佳治疗选择的证据有限。随着全球社会努力实现快速治疗 HIV 的目标和消除儿童结核病死亡，它必须确保合并感染儿童被纳入关键治疗研究，并扩大这一被忽视但至关重要的研究领域。
