Harshana Amit, Goyal Mohit, Chako Augustine, Mahajan Raman
International Training and Educational Center for Health (ITECH-India), New Delhi, Delhi.
Malawi Liverpool Welcome Programme, Blantyre.
Monaldi Arch Chest Dis. 2024 Jul 23. doi: 10.4081/monaldi.2024.2899.
The dual burden of human immunodeficiency virus (HIV) and tuberculosis (TB) impacts people living with HIV (PLHIV) coinfected with TB. Although some primary studies have been reported on the burden of extrapulmonary TB (EPTB) among PLHIV in Southeast Asia (SEA), there is no systematic review or meta-analysis that attempts to summarize the available literature. Therefore, this review aims to summarize the prevalence of EPTB/HIV co-infection in SEA using meta-analysis based on a systematic review of published articles and gray literature. A comprehensive 3-stage methodology was adopted to conduct a thorough literature search, encompassing both published and gray literature. Data sources such as MEDLINE and Web of Science were searched for articles reporting data from SEA between 2010 and 2022. Findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and were sourced using a predefined search strategy from different databases. The Joanna Briggs Institute prevalence studies checklist was employed for critical appraisal. The meta-analysis of proportions was carried out using the "metaprop" function in R software (version 4.3.1) to generate pooled estimates. Effects were summarized using random-effects models, and sources of heterogeneity were explored through I2, utilizing subgroup and sensitivity analyses. Publication bias was assessed using funnel plots and pertinent statistical tests, including Egger's regression analysis. A total of 474 studies were initially identified in our search. After the removal of duplicates and a meticulous screening process of titles and abstracts, along with the application of exclusion criteria, 22 studies comprising 34,740 PLHIV were included in the final meta-analysis. The summary effect or pooled proportion estimate of EPTB among PLHIV was found to be 18% [95% confidence interval (CI): 15,22; heterogeneity: τ2=0.0056; degrees of freedom=21, p<0.001; I2=99%]. Our study showed that there was a diverse range of prevalence of EPTB among PLHIV in the SEA region, which ranged from 5% (95% CI: 4.0-7.0) in South Korea to 48% (95% CI: 41.0-55.0) in Thailand. Our systematic review and meta-analysis indicate a notably higher prevalence of EPTB among PLHIV. Early diagnosis of EPTB is crucial to mitigating associated morbidity and mortality. Therefore, a thorough medical history and comprehensive physical examination are imperative in assessing PLHIV, aiming to promptly identify and rule out EPTB. After a diligent evaluation, appropriate diagnostic measures and tailored management strategies should be promptly instituted.
人类免疫缺陷病毒（HIV）和结核病（TB）的双重负担影响着合并感染TB的HIV感染者（PLHIV）。尽管已有一些关于东南亚（SEA）地区PLHIV肺外结核（EPTB）负担的初步研究报告，但尚无系统评价或荟萃分析对现有文献进行总结。因此，本综述旨在通过对已发表文章和灰色文献的系统评价，采用荟萃分析总结SEA地区EPTB/HIV合并感染的患病率。我们采用了全面的三阶段方法进行全面的文献检索，涵盖已发表文献和灰色文献。检索了MEDLINE和Web of Science等数据源，以查找报告2010年至2022年SEA地区数据的文章。研究结果按照系统评价和荟萃分析的首选报告项目指南进行报告，并使用来自不同数据库的预定义检索策略获取数据。采用乔安娜·布里格斯研究所患病率研究清单进行严格评价。使用R软件（版本4.3.1）中的“metaprop”函数进行比例的荟萃分析，以生成合并估计值。使用随机效应模型总结效应，并通过I2、亚组分析和敏感性分析探索异质性来源。使用漏斗图和相关统计检验（包括Egger回归分析）评估发表偏倚。在我们的检索中最初共识别出474项研究。在去除重复项并对标题和摘要进行细致筛选过程以及应用排除标准后，最终的荟萃分析纳入了22项研究，共34,740例PLHIV。PLHIV中EPTB的汇总效应或合并比例估计值为18%[95%置信区间（CI）：15,22；异质性：τ2=0.0056；自由度=21，p<0.001；I2=99%]。我们的研究表明，SEA地区PLHIV中EPTB的患病率范围广泛，从韩国的5%（95%CI：4.0 - 7.0）到泰国的48%（95%CI：41.0 - 55.0）。我们的系统评价和荟萃分析表明PLHIV中EPTB的患病率显著更高。EPTB的早期诊断对于降低相关发病率和死亡率至关重要。因此，在评估PLHIV时，详细的病史和全面的体格检查必不可少，旨在及时识别并排除EPTB。经过认真评估后，应及时采取适当的诊断措施和量身定制的管理策略。
