title: Early versus Delayed Antiretroviral Therapy for HIV and Tuberculosis Co-Infected Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  To compare important clinical outcomes between early and delayed initiation of antiretroviral therapy (ART) in adults who had a co-infection of human immunodeficiency virus (HIV) and tuberculosis (TB).
  
  
  METHODS
  We performed a systematic search for relevant publications on PubMed, EMBASE, and the International Clinical Trials Registry Platform. We included randomized controlled trials (RCTs) that compared early ART initiation (within four weeks after anti-TB treatment starting) and delayed ART initiation (after eight weeks but less than twelve weeks of anti-TB treatment starting) in the course of TB treatment. Pooled estimates with corresponding 95% confidence interval (95%CI) were calculated with random-effects model. Sensitivity analysis was performed to investigate the stability of pooled estimates.
  
  
  RESULTS
  A meta-analysis was evaluated from six RCTs with 2272 participants. Compared to delayed ART initiation, early ART initiation significantly reduces all-cause mortality in HIV-positive patients with TB [incidence rate ratio (IRR) 0.75, 95%CI 0.59 to 0.95; I2 = 0.00%; p = 0.67], even though there is an increased risk for IRD [IRR 2.29, 95%CI 1.81 to 2.91; I22 = 0.00%; p = 0.56]. Additionally, early ART initiation was not associated with an increased risk for grade 3-4 drug-related adverse events [IRR 0.99, 95%CI 0.83 to 1.18; I2 = 0.00%; p = 0.56].
  
  
  CONCLUSIONS
  Although limited evidence, our results provide support for early ART initiation in the course of anti-TB treatment. However, more well-designed cohort or intervention studies are required to further confirm our findings.
authors.affiliation: The Affiliated cancer hospital of Xiangya Scholl of Medicine, Central South University, Changsha, 410013 China.
authors.forename: Shipeng
authors.initials: S
authors.lastname: Yan
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, 410078 China.
authors.forename: Lizhang
authors.initials: L
authors.lastname: Chen
authors.affiliation: The Affiliated cancer hospital of Xiangya Scholl of Medicine, Central South University, Changsha, 410013 China.
authors.forename: Wenqiong
authors.initials: W
authors.lastname: Wu
authors.affiliation: Centers for Disease Control and Prevention of Hunan Province, Changsha, Hunan Province, 410005 China.
authors.forename: Zhongxi
authors.initials: Z
authors.lastname: Fu
authors.affiliation: Centers for Disease Control and Prevention of Changsha City, Changsha, Hunan Province, 410013 China.
authors.forename: Heng
authors.initials: H
authors.lastname: Zhang
authors.affiliation: The Affiliated cancer hospital of Xiangya Scholl of Medicine, Central South University, Changsha, 410013 China.
authors.forename: Zhanzhan
authors.initials: Z
authors.lastname: Li
authors.affiliation: Xiangya Hospital, Central South University, Changsha, Hunan Province, 41008 China.
authors.forename: Chenchao
authors.initials: C
authors.lastname: Fu
authors.affiliation: Changsha Medical University, Changsha, Hunan Province, 410000 China.
authors.forename: Jingsong
authors.initials: J
authors.lastname: Mou
authors.affiliation: The Affiliated cancer hospital of Xiangya Scholl of Medicine, Central South University, Changsha, 410013 China.
authors.forename: Jing
authors.initials: J
authors.lastname: Xue
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, 410078 China.
authors.forename: Yingyun
authors.initials: Y
authors.lastname: Hu
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy*; D004334:Drug Administration Schedule; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy*
chemical_list: D019380:Anti-HIV Agents