PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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 I 2 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.
UNASSIGNED: 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, I 2 = 92.9%, p = 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, I 2 = 84.4%, p = 0.001), compared to studies conducted in Harari and Addis Ababa regions, which had the proportions of 10% (95% CI: 6-13.1%, I 2 = 83.38%, p = 0.001) and 8% (95% CI: 1.1-15, I 2 = 87.6%, p = 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).
UNASSIGNED: 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.
UNASSIGNED: Trial registration number in Prospero =CRD42024509131 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=509131.
UNASSIGNED: 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 I 2 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.
UNASSIGNED: 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, I 2 = 92.9%, p = 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, I 2 = 84.4%, p = 0.001), compared to studies conducted in Harari and Addis Ababa regions, which had the proportions of 10% (95% CI: 6-13.1%, I 2 = 83.38%, p = 0.001) and 8% (95% CI: 1.1-15, I 2 = 87.6%, p = 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).
UNASSIGNED: 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.
UNASSIGNED: Trial registration number in Prospero =CRD42024509131 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=509131.
摘要：
尽管抗逆转录病毒疗法在降低HIV（PLHIV）感染者机会性感染死亡率方面有效，结核病（TB）仍然是一个重要的死亡原因，占所有死亡人数的三分之一以上。在埃塞俄比亚,在艾滋病毒合并感染期间，缺乏与结核病相关的死亡率的国家层面的全面和汇总数据。因此,本系统综述和荟萃分析旨在评估埃塞俄比亚结核病相关死亡率并确定PLHIV的危险因素.
■我们使用系统评价和荟萃分析的首选报告（PRISMA）指南对文献进行了广泛的系统评价。使用超过七个国际电子数据库从Scopus中提取了1,196篇已发表的文章，PubMed,MEDLINE,WebofScience,HINARY,谷歌学者，非洲在线杂志，手动搜索。使用STATA版本17使用加权逆方差随机效应元回归估计活动性TB的合并死亡率比例。文章的异质性采用CochranQ检验和I2统计检验进行评价。亚组分析,敏感性分析，并进行Egger回归调查发表偏倚。此系统评价在Prospero注册，具体编号为。CRD42024509131。
■总的来说，最终的荟萃分析报告包括22项单独研究。审查期间,共筛查了9,856例TB和HIV合并感染病例,报告了1,296例死亡.在最后的荟萃分析中，埃塞俄比亚PLHIV的合并结核病相关死亡率为16.2%(95%CI:13.0-19.2,I2=92.9%,p=0.001)。亚组分析显示，阿姆哈拉地区的结核病相关死亡率比例较高，据报道为21.1%(95%CI：18.1-28.0，I2=84.4%，p=0.001),与在哈拉里和亚的斯亚贝巴地区进行的研究相比，比例为10%(95%CI：6-13.1%，I2=83.38%，p=0.001)和8%(95%CI：1.1-15，I2=87.6%，p=0.001),分别。在随机效应元回归过程中，确定了与结核病和艾滋病毒合并感染死亡率相关的因素，包括WHO临床III和IV期(OR=3.01，95%CI：1.9-4.7)，漏用复方新诺明预防性治疗（CPT）（OR=1.89，95％CI：1.05-3.4），和错过异烟肼预防性治疗（IPT）（OR=1.8，95％CI：1.46-2.3）。
■在埃塞俄比亚，同时感染结核病/艾滋病毒的人的死亡率非常高，近五分之一（16％）的人在合并感染期间死亡；与其他非洲国家相比，这一比率被认为更高。确定了合并感染期间死亡的危险因素；纳入的研究检查了晚期WHO临床阶段IV和III，血红蛋白水平（≤10mg/dL），错过了异烟肼预防性治疗（IPT），和错过复方新诺明预防性治疗（CPT）作为预测因子。为了减少过早死亡，医疗保健提供者必须优先考虑主动结核病筛查，确保及时诊断，并在每次连续访问中提供营养咨询。
■Prospero中的试用注册号=CRD42024509131https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=509131。
■我们使用系统评价和荟萃分析的首选报告（PRISMA）指南对文献进行了广泛的系统评价。使用超过七个国际电子数据库从Scopus中提取了1,196篇已发表的文章，PubMed,MEDLINE,WebofScience,HINARY,谷歌学者，非洲在线杂志，手动搜索。使用STATA版本17使用加权逆方差随机效应元回归估计活动性TB的合并死亡率比例。文章的异质性采用CochranQ检验和I2统计检验进行评价。亚组分析,敏感性分析，并进行Egger回归调查发表偏倚。此系统评价在Prospero注册，具体编号为。CRD42024509131。
■总的来说，最终的荟萃分析报告包括22项单独研究。审查期间,共筛查了9,856例TB和HIV合并感染病例,报告了1,296例死亡.在最后的荟萃分析中，埃塞俄比亚PLHIV的合并结核病相关死亡率为16.2%(95%CI:13.0-19.2,I2=92.9%,p=0.001)。亚组分析显示，阿姆哈拉地区的结核病相关死亡率比例较高，据报道为21.1%(95%CI：18.1-28.0，I2=84.4%，p=0.001),与在哈拉里和亚的斯亚贝巴地区进行的研究相比，比例为10%(95%CI：6-13.1%，I2=83.38%，p=0.001)和8%(95%CI：1.1-15，I2=87.6%，p=0.001),分别。在随机效应元回归过程中，确定了与结核病和艾滋病毒合并感染死亡率相关的因素，包括WHO临床III和IV期(OR=3.01，95%CI：1.9-4.7)，漏用复方新诺明预防性治疗（CPT）（OR=1.89，95％CI：1.05-3.4），和错过异烟肼预防性治疗（IPT）（OR=1.8，95％CI：1.46-2.3）。
■在埃塞俄比亚，同时感染结核病/艾滋病毒的人的死亡率非常高，近五分之一（16％）的人在合并感染期间死亡；与其他非洲国家相比，这一比率被认为更高。确定了合并感染期间死亡的危险因素；纳入的研究检查了晚期WHO临床阶段IV和III，血红蛋白水平（≤10mg/dL），错过了异烟肼预防性治疗（IPT），和错过复方新诺明预防性治疗（CPT）作为预测因子。为了减少过早死亡，医疗保健提供者必须优先考虑主动结核病筛查，确保及时诊断，并在每次连续访问中提供营养咨询。
■Prospero中的试用注册号=CRD42024509131https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=509131。
