Mohammed Hussen, Assefa Nega, Mengistie Bezatu
School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
HIV AIDS (Auckl). 2018 Nov 5;10:225-237. doi: 10.2147/HIV.S176587. eCollection 2018.
The double burden of infectious diseases such as tuberculosis (TB) and HIV disproportionately affects Africa. Our objective was to summarize the prevalence of extrapulmonary TB (EPTB) among people living with HIV/AIDS (PLWHA) in sub-Saharan Africa (SSA).
We searched PubMed and Google Scholar for studies done on the prevalence of EPTB among PLWHA which published in English from 1990 to 2017. We also searched bibliographic indices and browsed through reference lists of articles and journals. We critically appraised the quality of articles and abstracted the data with Joanna Briggs Institute (JBI) checklists. We used Review Manager Software (version 5.3) and Compressive Meta-analysis Software (version 2.2) for analysis. Finally, we summarized the effect estimate by using random-effects model and explored potential sources of heterogeneity by subgroup and sensitivity analyses. We assessed publication bias by funnel plot and statistical test. Finally, we used PRISMA format for reporting.
We included, in this review, 31 studies that fulfilled our inclusion criteria, with a total population of 28,659. The prevalence estimate of EPTB among PLWHA ranged from 6.4% (95% CI: 3.8, 9.0) to 36.8% (95% CI: 28.6, 45); random-effects pooled prevalence of EPTB among PLWHA was found to be 20% (95% CI: 17, 22; heterogeneity: τ=0; χ=509.09, degrees of freedom []=30, <0.00001; =94%). No evidence of publication bias was observed (=0.44 for Egger's regression analysis and =0.11 for Begg's rank correlation analysis).
We can conclude from our analyses that the prevalence of EPTB among PLWHA was high. It is necessary to give emphasis for EPTB, especially when screening TB among PLWHA, widening the spectrum of screening to include all EPTB sites in the countries with high EPTB and/or HIV prevalence in the general population.
结核病（TB）和艾滋病毒等传染病的双重负担对非洲的影响尤为严重。我们的目标是总结撒哈拉以南非洲（SSA）地区艾滋病毒/艾滋病感染者（PLWHA）中肺外结核（EPTB）的患病率。
我们在PubMed和谷歌学术上搜索了1990年至2017年以英文发表的关于PLWHA中EPTB患病率的研究。我们还搜索了文献索引，并浏览了文章和期刊的参考文献列表。我们严格评估了文章质量，并使用乔安娜·布里格斯研究所（JBI）检查表提取数据。我们使用Review Manager软件（5.3版）和综合荟萃分析软件（2.2版）进行分析。最后，我们使用随机效应模型总结效应估计值，并通过亚组分析和敏感性分析探索异质性的潜在来源。我们通过漏斗图和统计检验评估发表偏倚。最后，我们使用PRISMA格式进行报告。
在本综述中，我们纳入了31项符合纳入标准的研究，总样本量为28659。PLWHA中EPTB的患病率估计范围为6.4%（95%CI：3.8，9.0）至36.8%（95%CI：28.6，45）；PLWHA中EPTB的随机效应合并患病率为20%（95%CI：17，22；异质性：τ=0；χ=509.09，自由度[]=30，<0.00001；I²=94%）。未观察到发表偏倚的证据（Egger回归分析的P值=0.44，Begg秩相关分析的P值=0.11）。
从我们的分析中可以得出结论，PLWHA中EPTB的患病率很高。有必要重视EPTB，特别是在对PLWHA进行结核病筛查时，扩大筛查范围，将所有EPTB部位纳入EPTB和/或普通人群中艾滋病毒患病率较高国家的筛查范围。
