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Abstract：
BACKGROUND: Multi-drug or rifamycin-resistant tuberculosis (MDR/RR-TB) is an important public health concern, including in settings with high HIV prevalence. TB drug resistance can be directly transmitted or arise through resistance acquisition during first-line TB treatment. Limited evidence suggests that people living with HIV (PLHIV) might have an increased risk of acquired rifamycin-resistance (ARR).
METHODS: To assess HIV as a risk factor for ARR during first-line TB treatment, a systematic review and meta-analysis was conducted. ARR was defined as rifamycin-susceptibility at treatment start with rifamycin-resistance diagnosed during or at the end of treatment, or at recurrence. PubMed/MEDLINE, CINAHL, Cochrane Library, and Google Scholar databases were searched from inception to 23 May 2024 for articles in English; conference abstracts were also searched from 2004 to 2021. The Mantel-Haenszel random-effects model was used to estimate the pooled odds ratio of any association between HIV and ARR among individuals receiving first-line TB treatment.
RESULTS: Ten studies that included data collected between 1990 and 2014 were identified: five from the United States, two from South Africa and one each from Uganda, India and Moldova. A total of 97,564 individuals were included across all studies, with 13,359 (13.7%) PLHIV. Overall, 312 (0.32%) acquired rifamycin-resistance, among whom 115 (36.9%) were PLHIV. The weighted odds of ARR were 4.57 (95% CI, 2.01-10.42) times higher among PLHIV compared to HIV-negative individuals receiving first-line TB treatment.
CONCLUSIONS: The available data, suggest that PLHIV have an increased ARR risk during first-line TB treatment. Further research is needed to clarify specific risk factors, including advanced HIV disease and TB disease severity. Given the introduction of shorter, 4-month rifamycin-based regimens, there is an urgent need for additional data on ARR, particularly for PLHIV.
BACKGROUND: PROSPERO CRD42022327337.
METHODS: To assess HIV as a risk factor for ARR during first-line TB treatment, a systematic review and meta-analysis was conducted. ARR was defined as rifamycin-susceptibility at treatment start with rifamycin-resistance diagnosed during or at the end of treatment, or at recurrence. PubMed/MEDLINE, CINAHL, Cochrane Library, and Google Scholar databases were searched from inception to 23 May 2024 for articles in English; conference abstracts were also searched from 2004 to 2021. The Mantel-Haenszel random-effects model was used to estimate the pooled odds ratio of any association between HIV and ARR among individuals receiving first-line TB treatment.
RESULTS: Ten studies that included data collected between 1990 and 2014 were identified: five from the United States, two from South Africa and one each from Uganda, India and Moldova. A total of 97,564 individuals were included across all studies, with 13,359 (13.7%) PLHIV. Overall, 312 (0.32%) acquired rifamycin-resistance, among whom 115 (36.9%) were PLHIV. The weighted odds of ARR were 4.57 (95% CI, 2.01-10.42) times higher among PLHIV compared to HIV-negative individuals receiving first-line TB treatment.
CONCLUSIONS: The available data, suggest that PLHIV have an increased ARR risk during first-line TB treatment. Further research is needed to clarify specific risk factors, including advanced HIV disease and TB disease severity. Given the introduction of shorter, 4-month rifamycin-based regimens, there is an urgent need for additional data on ARR, particularly for PLHIV.
BACKGROUND: PROSPERO CRD42022327337.
摘要：
背景：耐多药或利福霉素的结核病（MDR/RR-TB）是重要的公共卫生问题，包括在艾滋病毒高流行的环境中。在一线TB治疗期间，TB耐药性可以直接传播或通过耐药性获得而产生。有限的证据表明，艾滋病毒感染者（PLHIV）可能会增加获得性利福霉素耐药性（ARR）的风险。
方法：为了评估一线结核病治疗期间HIV作为ARR的危险因素，我们进行了系统评价和荟萃分析.ARR定义为治疗开始时的利福霉素敏感性，治疗期间或治疗结束时诊断为利福霉素耐药。或复发。PubMed/MEDLINE,CINAHL,科克伦图书馆,从成立到2024年5月23日，搜索了GoogleScholar数据库中的英文文章；从2004年到2021年还搜索了会议摘要。Mantel-Haenszel随机效应模型用于估计接受一线结核病治疗的个体中HIV和ARR之间任何关联的合并比值比。
结果：确定了包含1990年至2014年收集的数据的10项研究：5项来自美国，两个来自南非，一个来自乌干达，印度和摩尔多瓦。所有研究共纳入97,564人，13,359（13.7%）感染艾滋病毒。总的来说,312（0.32%）获得利福霉素抗性，其中115人（36.9%）为PLHIV。与接受一线结核病治疗的HIV阴性个体相比，PLHIV的ARR加权几率为4.57（95％CI，2.01-10.42）倍。
结论：现有数据，提示PLHIV在一线TB治疗期间有增加的ARR风险.需要进一步的研究来澄清具体的风险因素，包括晚期HIV疾病和结核病的严重程度。鉴于较短的引入，4个月利福霉素为基础的方案，迫切需要更多关于ARR的数据，特别是PLHIV。
背景：PROSPEROCRD42022327337。
方法：为了评估一线结核病治疗期间HIV作为ARR的危险因素，我们进行了系统评价和荟萃分析.ARR定义为治疗开始时的利福霉素敏感性，治疗期间或治疗结束时诊断为利福霉素耐药。或复发。PubMed/MEDLINE,CINAHL,科克伦图书馆,从成立到2024年5月23日，搜索了GoogleScholar数据库中的英文文章；从2004年到2021年还搜索了会议摘要。Mantel-Haenszel随机效应模型用于估计接受一线结核病治疗的个体中HIV和ARR之间任何关联的合并比值比。
结果：确定了包含1990年至2014年收集的数据的10项研究：5项来自美国，两个来自南非，一个来自乌干达，印度和摩尔多瓦。所有研究共纳入97,564人，13,359（13.7%）感染艾滋病毒。总的来说,312（0.32%）获得利福霉素抗性，其中115人（36.9%）为PLHIV。与接受一线结核病治疗的HIV阴性个体相比，PLHIV的ARR加权几率为4.57（95％CI，2.01-10.42）倍。
结论：现有数据，提示PLHIV在一线TB治疗期间有增加的ARR风险.需要进一步的研究来澄清具体的风险因素，包括晚期HIV疾病和结核病的严重程度。鉴于较短的引入，4个月利福霉素为基础的方案，迫切需要更多关于ARR的数据，特别是PLHIV。
背景：PROSPEROCRD42022327337。
