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Increasing Burden of Multidrug Resistant Tuberculosis in HIV Infected Individuals: A Systematic Review and Meta-Analysis

70 Pages Posted: 8 Feb 2020

See all articles by Zeeba Zahra Sultana

Zeeba Zahra Sultana

North South University - Department of Public Health

Farhana Ul Hoque

North South University - Department of Public Health

Joseph Beyene

McMaster University - Department of Health Research Methods, Evidence, and Impact (HEI)

Md. Akhlak-Ul-Islam

McMaster University - Department of Health Research Methods, Evidence, and Impact (HEI)

Md. Hasinur Rahman Khan

University of Dhaka

Mohammad Delwer Hossain Hawlader

North South University - Department of Public Health

Gias U. Ahsan

North South University - Department of Public Health

Shakil Ahmed

North South University - Department of Public Health

Ahmed Hossain

North South University - Department of Public Health; Health Management Research Foundation

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Abstract

Background: The increasing burden of multidrug-resistant tuberculosis (MDR-TB) in HIV infected individuals is a serious threat to global tuberculosis control programs. The study aimed to summarize the available evidences on the association of HIV infection and the development of MDR-TB and, finally, to provide an up-to-datepooled estimate of risks.

Methods: We searched on PubMed, Google Scholar, and ScienceDirect databases to select eligible studies for our systematic review and meta-analysis, published between January 1, 2010, and July 30,2019. Two sets of reviewers independently extracted data and assessed the methodological quality of the studies using the Newcastle-Ottawa Scale. Subgroup analysis was pre-specified to perform according to the continent, country, income level, study design, mean/median age, and type of MDR-TB. The random-effects model was used to obtain the pooled odds ratio of the crude association between HIV infection and MDR-TB with a 95% confidence interval. We investigated the potential publication bias by checking funnel plot asymmetry and using the Egger’s test. Moreover, we assessed the heterogeneity using Cochran’s Q test and the I2 statistic.

Findings: We identified 1496 studies through a database search, and after subsequent elimination based on our eligibility criteria, we selected 47 articles, including 60,754 participants. The pooled odds ratio was 1.47 (95% CI= 1.19-1.81) with substantial heterogeneity (I2=80.49%), and there was no evidence of publication bias (p=0.13). Subgroup analysis revealed that the estimated pooled odds ratio for European countries (OR=2.31, 95% CI= 1.80-2.96, I2=32.26%) was higher than the other three continents (South American, Asia, and Africa). Further analysis showed that the effect estimate was higher for primary MDR-TB (OR=3.13, 95% CI= 1.59-6.13, I2=13.13%) with no heterogeneity among the studies. There was also a trend towards increased risk of MDR-TB for HIV patients of 40 years and older (OR=1.96, 95% CI= 1.41-2.73, I2=69.11%) and women HIV patients (OR=1.97, 95% CI 1.03-3.78, I2=80.35%). The MDR-TB is found to be significant in high burden of TB/HIV countries (OR=1.51, 95% CI= 1.18-1.92, I2=78.1%) and in high-income countries (OR=2.64, 95% CI= 2.01-3.48, I2=15.01%).

Interpretation:The risk of MDR-TB increases significantly among HIV infected individuals from the last decade. The most considerable burden of MDR-TB in HIV individuals was found in Europe and the women HIV patients with age 40 years and older are most in the risk of MDR-TB.

Funding Statement: The authors stated: "There was a student seed fund for this study. The corresponding author had full access to all study data and the authorized person for the final submission of the paper for publication."

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: The protocol was registered with PROSPERO-CRD42019132752.

Keywords: Multidrug-resistant tuberculosis; HIV; MDR-TB; systematic review; meta-analysis

Suggested Citation

Sultana, Zeeba Zahra and Hoque, Farhana Ul and Beyene, Joseph and Akhlak-Ul-Islam, Md. and Khan, Md. Hasinur Rahman and Hawlader, Mohammad Delwer Hossain and Ahsan, Gias U. and Ahmed, Shakil and Hossain, Ahmed, Increasing Burden of Multidrug Resistant Tuberculosis in HIV Infected Individuals: A Systematic Review and Meta-Analysis (January 22, 2020). Available at SSRN: https://ssrn.com/abstract=3523868 or http://dx.doi.org/10.2139/ssrn.3523868

Zeeba Zahra Sultana

North South University - Department of Public Health

Dhaka
Bangladesh

Farhana Ul Hoque

North South University - Department of Public Health

Dhaka
Bangladesh

Joseph Beyene

McMaster University - Department of Health Research Methods, Evidence, and Impact (HEI)

Hamilton, Ontario L8N 3Z5
Canada

Md. Akhlak-Ul-Islam

McMaster University - Department of Health Research Methods, Evidence, and Impact (HEI)

Hamilton, Ontario L8N 3Z5
Canada

Md. Hasinur Rahman Khan

University of Dhaka

University of Dhaka
Ramna, Dhaka, 1000
Bangladesh

Mohammad Delwer Hossain Hawlader

North South University - Department of Public Health

Dhaka
Bangladesh

Gias U. Ahsan

North South University - Department of Public Health ( email )

Dhaka
Bangladesh

Shakil Ahmed

North South University - Department of Public Health

Dhaka
Bangladesh

Ahmed Hossain (Contact Author)

North South University - Department of Public Health ( email )

Dhaka
Bangladesh

Health Management Research Foundation ( email )

Dhaka
Bangladesh

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