title: TB as a cause of hospitalization and in-hospital mortality among people living with HIV worldwide: a systematic review and meta-analysis.
abstract: BACKGROUND
  Despite significant progress in improving access to antiretroviral therapy over the past decade, substantial numbers of people living with HIV (PLHIV) in all regions continue to experience severe illness and require hospitalization. We undertook a global review assessing the proportion of hospitalizations and in-hospital deaths because of tuberculosis (TB) in PLHIV.
  
  
  METHODS
  Seven databases were searched to identify studies reporting causes of hospitalizations among PLHIV from 1 January 2007 to 31 January 2015 irrespective of age, geographical region or language. The proportion of hospitalizations and in-hospital mortality attributable to TB was estimated using random effects meta-analysis.
  
  
  RESULTS
  From an initial screen of 9049 records, 66 studies were identified, providing data on 35,845 adults and 2792 children across 42 countries. Overall, 17.7% (95% CI 16.0 to 20.2%) of all adult hospitalizations were because of TB, making it the leading cause of hospitalization overall; the proportion of adult hospitalizations because of TB exceeded 10% in all regions except the European region. Of all paediatric hospitalizations, 10.8% (95% CI 7.6 to 13.9%) were because of TB. There was insufficient data among children for analysis by region. In-hospital mortality attributable to TB was 24.9% (95% CI 19.0 to 30.8%) among adults and 30.1% (95% CI 11.2 to 48.9%) among children.
  
  
  CONCLUSIONS
  TB remains a leading cause of hospitalization and in-hospital death among adults and children living with HIV worldwide.
authors.affiliation: Department of HIV, World Health Organization, Geneva, Switzerland; fordn@who.int.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Global TB Programme, World Health Organization, Geneva, Switzerland.|Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV and TB Elimination, University of Brescia, Brescia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Matteelli
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
authors.forename: Zara
authors.initials: Z
authors.lastname: Shubber
authors.affiliation: Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.|Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.
authors.forename: Sabine
authors.initials: S
authors.lastname: Hermans
authors.affiliation: Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Ministry of Health, Rio de Janeiro, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: University of Maryland school of Medicine, Baltimore, MD, USA.
authors.forename: Greer
authors.initials: G
authors.lastname: Waldrop
authors.affiliation: Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.|National and Supranational Tuberculosis Reference Laboratory, Research Centre Borstel, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Kranzer
authors.affiliation: Department of HIV, World Health Organization, Geneva, Switzerland.
authors.forename: Meg
authors.initials: M
authors.lastname: Doherty
authors.affiliation: Global TB Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Haileyesus
authors.initials: H
authors.lastname: Getahun
mesh_terms: D000328:Adult; D002648:Child; D015658:HIV Infections / Q000150:complications*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D014376:Tuberculosis / Q000401:mortality*
keywords: HIV/AIDS; hospitalization; morbidity; mortality; tuberculosis