College of Health Sciences, Woldia University, Woldia, Ethiopia.
Faculties of Social Science, Geography department, Bahir Dare University, Bahir Dare, Ethiopia.
Front Public Health. 2024 Jul 22;12:1386113. doi: 10.3389/fpubh.2024.1386113. eCollection 2024.
Despite the effectiveness of antiretroviral therapy in reducing mortality from opportunistic infections among people living with HIV (PLHIV), tuberculosis (TB) continues to be a significant cause of death, accounting for over one-third of all deaths in this population. In Ethiopia, there is a lack of comprehensive and aggregated data on the national level for TB-associated mortality during co-infection with HIV. Therefore, this systematic review and meta-analysis aimed to estimate TB-associated mortality and identify risk factors for PLHIV in Ethiopia.
We conducted an extensive systematic review of the literature using the Preferred Reporting of Systematic Review and Meta-Analysis (PRISMA) guidelines. More than seven international electronic databases were used to extract 1,196 published articles from Scopus, PubMed, MEDLINE, Web of Science, HINARY, Google Scholar, African Journal Online, and manual searching. The pooled mortality proportion of active TB was estimated using a weighted inverse variance random-effects meta-regression using STATA version-17. The heterogeneity of the articles was evaluated using Cochran's Q test and statistic test. Subgroup analysis, sensitivity analysis, and Egger's regression were conducted to investigate publication bias. This systematic review is registered in Prospero with specific No. CRD42024509131.
Overall, 22 individual studies were included in the final meta-analysis reports. During the review, a total of 9,856 cases of TB and HIV co-infection were screened and 1,296 deaths were reported. In the final meta-analysis, the pooled TB-associated mortality for PLHIV in Ethiopia was found to be 16.2% (95% CI: 13.0-19.2, = 92.9%, = 0.001). The subgroup analysis revealed that the Amhara region had a higher proportion of TB-associated mortality, which was reported to be 21.1% (95% CI: 18.1-28.0, = 84.4%, = 0.001), compared to studies conducted in Harari and Addis Ababa regions, which had the proportions of 10% (95% CI: 6-13.1%, = 83.38%, = 0.001) and 8% (95% CI: 1.1-15, = 87.6%, = 0.001), respectively. During the random-effects meta-regression, factors associated with co-infection of mortality in TB and HIV were identified, including WHO clinical stages III & IV (OR = 3.01, 95% CI: 1.9-4.7), missed co-trimoxazole preventive therapy (CPT) (OR = 1.89, 95% CI: 1.05-3.4), and missed isoniazid preventive therapy (IPT) (OR = 1.8, 95% CI: 1.46-2.3).
In Ethiopia, the mortality rate among individuals co-infected with TB/HIV is notably high, with nearly one-fifth (16%) of individuals succumbing during co-infection; this rate is considered to be higher compared to other African countries. Risk factors for death during co-infection were identified; the included studies examined advanced WHO clinical stages IV and III, hemoglobin levels (≤10 mg/dL), missed isoniazid preventive therapy (IPT), and missed cotrimoxazole preventive therapy (CPT) as predictors. To reduce premature deaths, healthcare providers must prioritize active TB screening, ensure timely diagnosis, and provide nutritional counseling in each consecutive visit.
Trial registration number in Prospero =CRD42024509131 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=509131.
尽管抗逆转录病毒疗法在降低艾滋病毒感染者（PLHIV）机会性感染导致的死亡率方面非常有效，但结核病（TB）仍然是导致死亡的一个重要原因，占这一人群所有死亡人数的三分之一以上。在埃塞俄比亚，缺乏全国范围内 HIV 合并感染相关 TB 死亡率的综合和汇总数据。因此，本系统评价和荟萃分析旨在估计 TB 相关死亡率，并确定 PLHIV 的危险因素。
我们按照系统评价和荟萃分析的首选报告（PRISMA）指南进行了广泛的文献系统评价。我们使用 Scopus、PubMed、MEDLINE、Web of Science、HINARY、Google Scholar、African Journal Online 和手动搜索等七个国际电子数据库提取了 1196 篇已发表的文章。使用 STATA 版本-17 的加权倒数方差随机效应荟萃回归估计活动性 TB 的合并死亡率。使用 Cochrane's Q 检验和 统计检验评估文章的异质性。进行亚组分析、敏感性分析和 Egger 回归以调查发表偏倚。本系统评价已在 Prospero 中注册，具体编号为 CRD42024509131。
共有 22 项单独的研究被纳入最终的荟萃分析报告。在审查过程中，共筛选了 9856 例 TB 和 HIV 合并感染病例，并报告了 1296 例死亡。在最终的荟萃分析中，发现埃塞俄比亚 PLHIV 的 TB 相关死亡率为 16.2%（95% CI：13.0-19.2， =92.9%， =0.001）。亚组分析显示，阿姆哈拉地区的 TB 相关死亡率较高，为 21.1%（95% CI：18.1-28.0， =84.4%， =0.001），而在哈拉里和亚的斯亚贝巴地区进行的研究中，TB 相关死亡率分别为 10%（95% CI：6-13.1%， =83.38%， =0.001）和 8%（95% CI：1.1-15， =87.6%， =0.001）。在随机效应荟萃回归中，确定了与 TB 和 HIV 合并感染死亡率相关的因素，包括世界卫生组织临床分期 III & IV（OR=3.01，95% CI：1.9-4.7）、错过复方磺胺甲噁唑预防治疗（CPT）（OR=1.89，95% CI：1.05-3.4）和错过异烟肼预防治疗（IPT）（OR=1.8，95% CI：1.46-2.3）。
在埃塞俄比亚，TB/HIV 合并感染者的死亡率相当高，近五分之一（16%）的感染者在合并感染期间死亡，这一比例被认为高于其他非洲国家。确定了死亡的危险因素；纳入的研究检查了晚期世界卫生组织临床分期 IV 和 III、血红蛋白水平（≤10mg/dL）、错过异烟肼预防治疗（IPT）和错过复方磺胺甲噁唑预防治疗（CPT）作为预测因素。为了减少过早死亡，医疗保健提供者必须优先进行活动性 TB 筛查，确保及时诊断，并在每次随访中提供营养咨询。
