1st Journal Reading

Association Between HIV/AIDS

and Multi-Drug Resistance
Tuberculosis:
A Systematic Review and
Meta-Analysis
dr. Alexander Kam
Internal Medicine Department
RSUP Dr. M Djamil Padang - 2014

Association Between HIV/AIDS and Multi-Drug Resistance Tuberculosis:

A Systematic Review and Meta-Analysis

INTRODUCTION

Introduction

Tuberculosis

Chronic
infectious
disease

Mycobacterium
tuberculosis
Other
Mycobacterium
complex

Tuberculosis
Major cause of
morbidity and mortality
1/3 world have been
infected

Introduction
2010

8.8 million

Incident Cases

Deaths caused by TB

1.1 million

HIV-negative

0.35 million

HIV-associated TB

MDRTB
HIV
TB
Control
Program

XDRTB

Absence of
treatment for
MDR-TB

Major
challenge for
TB control
program

MDR - TB

 650.000

New
Case

5% of all TB

Death

Case
fatality
rate

150.000

30 / 100
individuals

HIV

Higher risk of:

MDRTB

XDRTB

HIV
Balanced
deadlier
combination

MDRTB

Relationship?

Association Between HIV/AIDS and Multi-Drug Resistance Tuberculosis:

A Systematic Review and Meta-Analysis

METHODS

Study Design & Data Source

Systematic
Review

MetaAnalysis

Study Design & Data Source

Computerized

Hand searching

Medline/ Pubmed

Int. Journal of TB &

Lung Disease

Google Scholar
HINARI

Study Selection

Observational Studies
Crosssectional

Surveillance

Case
control

Cohort

Eligibility Criteria
Drug susceptibility to Rifampicin
and Isoniazid of MTB
Stratified by HIV status

Exclusion Criteria
Extrapulmonary
TB

Mycobacterium
other than TB

HIV is not
considered as
risk factor

Not give effect

estimated on
OR, RR, risk
ratio

Children <15
years old

Meta-analysis or
systematic
review

Duplicate
publication

Only abstract

Sample size <50

High Quality Studies

Outcomes on at least 50 patients

Cohort with lost follow up of less than 20%

Case control

Response rate >80%

Reported basic demographic data, clear
stratification, and adjustment for covariates

Data Synthesis
Drug resistance
Resistance to 1 or more first line drug

Mono resistance
One of the 5 first-line drugs

Primary or Initial Resistance

Never been treated or treatment < 1 month

Secondary Resistance
Acquired resistance during the treatment

Association Between HIV/AIDS and Multi-Drug Resistance Tuberculosis:

A Systematic Review and Meta-Analysis

RESULTS

Association Between HIV/AIDS and Multi-Drug Resistance Tuberculosis:

A Systematic Review and Meta-Analysis

DISCUSSION

The odds having MDR-TB among HIV+ ?

24 %

HIV+ > HIV-

40%
Not satistically significant

HIV

Significant
with primary
Not associated
with secondary

Biological Mechanism
Faster progress of
infection
Drugs mal-absorbtion

Treatment Failure

Association Between HIV/AIDS and Multi-Drug Resistance Tuberculosis:

A Systematic Review and Meta-Analysis

CONCLUSION

This study found consistent but

marginal evidence for:

Risk of MDR TB
People with HIV infection

Implication?

Public health importance

Diagnosis of MDR-TB
Initiating and scale up of
ARV treatment
Strengthened HIV and TB
control program

Early case
detection
Qualityassured
bacteriology

Reduce risk
of spread of
MDR-TB

Provide
standardized
treatment

Good
infection
control

The question (PICO) of the study

Population/

HIV/AIDS patient that suffered

Problem

from MDR-TB.

Intervention

No intervention.

Comparison

No comparison

Outcome

There is association between

MDR-TB and HIV

Association Between HIV/AIDS and Multi-Drug Resistance Tuberculosis:

A Systematic Review and Meta-Analysis

CRITICAL APPRAISAL

DOES THIS REVIEW ADDRESS A

CLEAR QUESTION?
1. Did the review address a clearly focused issue?

Yes

Cant
tell

Was there enough information on

The population studied

The intervention given

The outcomes considered

2. Did the authors look for the appropriate sort of

papers?
The best sort of studies would

Address the reviews question

Have an appropriate study design

No

ARE THE RESULT OF THIS REVIEW VALID?

3. Do you think the important, relevant studies were

Yes

included?

tell

Look for

Which bibliographic database were used

Follow up from reference lists

Personal contact with experts

Search for unpublished as well as published studies

Search for non English language studies

4. Did the reviews authors do enough to assess the quality

of the included studies?
The authors need to consider the rigour of the studies they
have identified. Lack of rigour may affect the studies
results

Cant

No

ARE THE RESULT OF THIS REVIEW VALID?

5. If the results of the review have been combined,
was it reasonable to do so?
Consider whether

The results were similar from study to study

The result of all the included studies are clearly

displayed

The results of the different studies are similar

The reasons for any variations are discussed

WHAT ARE THE RESULTS?

6. What is the overall result of the
review?
Consider

If you are clear about the Yes

reviews bottom line results

What these are

There is association between MDRTB and HIV

7. How precise are the results?

Are the

results presented with Yes

confidence intervals?

...thank you