title: Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review.
abstract: BACKGROUND
  Use of antiretroviral therapy (ART) during treatment of drug susceptible tuberculosis (TB) improves survival. However, data from HIV infected individuals with drug resistant TB are lacking. Second line TB drugs when combined with ART may increase drug interactions and lead to higher rates of toxicity and greater noncompliance. This systematic review sought to determine the benefit of ART in the setting of second line drug therapy for drug resistant TB.
  
  
  METHODS
  We included individual patient data from studies that evaluated treatment of drug-resistant tuberculosis in HIV-1 infected individuals published between January 1980 and December of 2009. We evaluated the effect of ART on treatment outcomes, time to smear and culture conversion, and adverse events.
  
  
  RESULTS
  Ten observational studies, including data from 217 subjects, were analyzed. Patients using ART during TB treatment had increased likelihood of cure (hazard ratio (HR) 3.4, 95% CI 1.6-7.4) and decreased likelihood of death (HR 0.4, 95% CI 0.3-0.6) during treatment for drug resistant TB. These associations remained significant in patients with a CD4 less than 200 cells/mm(3) and less than 50 cells/mm(3), and when correcting for drug resistance pattern.
  
  
  CONCLUSIONS
  We identified only observational studies from which individual patient data could be drawn. Limitations in study design, and heterogeneity in a number of the outcomes of interest had the potential to introduce bias.
  
  
  CONCLUSIONS
  While there are insufficient data to determine if ART use increases adverse drug interactions when used with second line TB drugs, ART use during treatment of drug resistant TB appears to improve cure rates and decrease risk of death. All individuals with HIV appear to benefit from ART use during treatment for TB.
authors.affiliation: The University of Washington, Seattle, Washington, United States of America. marentz@u.washington.edu
authors.forename: Matthew
authors.initials: M
authors.lastname: Arentz
authors.forename: Patricia
authors.initials: P
authors.lastname: Pavlinac
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kimerling
authors.forename: David J
authors.initials: DJ
authors.lastname: Horne
authors.forename: Dennis
authors.initials: D
authors.lastname: Falzon
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
authors.forename: Sarah
authors.initials: S
authors.lastname: Royce
authors.forename: Keertan
authors.initials: K
authors.lastname: Dheda
authors.forename: Judd L
authors.initials: JL
authors.lastname: Walson
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D009161:Mycobacterium / Q000302:isolation & purification; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents