title: The effect of tuberculosis treatment at combination antiretroviral therapy initiation on subsequent mortality: a systematic review and meta-analysis.
abstract: OBJECTIVE
  We aimed to perform a systematic review and meta-analysis examining the impact of TB treatment at the time of combination antiretroviral therapy (cART) initiation on subsequent mortality.
  
  
  METHODS
  We searched PubMed, EMBASE, and selected conference proceedings for studies that report adult mortality on cART, stratified by TB treatment status at cART initiation. Stratified random-effects and meta-regression analyses were used to examine the influence of study and population characteristics.
  
  
  RESULTS
  22 eligible cohort studies reported data on 98,350 (range 74-15,225) adults, of whom 14,779 (15%) were receiving TB treatment at cART initiation. Studies of those receiving vs. not receiving TB treatment had an average mortality relative risk of 1.10 (95% confidence interval 0.87-1.40) at 1-3 months (based upon 8 estimates), 1.15 (0.94-1.41) at 6-12 months (11 estimates), and 1.33 (1.02-1.75) at 18-98 months (10 estimates) following cART initiation. However, there was a wide range of estimates and those at later time points were markedly heterogeneous. Meta-regression identified factors associated with elevated average risk estimates: lower median baseline CD4 counts and adjustment for baseline hemoglobin at 1-3 months; longer length of follow-up and women-only studies at 6-12 months; and not adjusting for BMI/weight at 18-98 months.
  
  
  CONCLUSIONS
  Patients receiving TB treatment at cART initiation did not have a statistically significant estimated increase in short-term risk of all-cause mortality as compared to those not receiving TB treatment. TB treatment was significantly associated with increased mortality after about a year of cART, suggesting that patients with concurrent TB treatment at cART initiation may benefit from continued support after TB treatment completion.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Soeters
authors.forename: Charles
authors.initials: C
authors.lastname: Poole
authors.forename: Monita R
authors.initials: MR
authors.lastname: Patel
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D006801:Humans; D012306:Risk; D014376:Tuberculosis / Q000188:drug therapy* / Q000401:mortality*
chemical_list: D044966:Anti-Retroviral Agents; D004338:Drug Combinations