Transmission Dynamics in Tuberculosis Patients With Human Immunodeficiency Virus: A Systematic Review and Meta-analysis of 32 Observational Studies.

Autor:	Martinez L; Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA.; Center for Global Health, College of Public Health, University of Georgia, Athens, Georgia, USA.; Stanford University, School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, California, USA., Woldu H; Biostatistics & Research Design Unit School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA., Chen C; Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China.; Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China.; School of Public Health, Fudan University, Shanghai, China., Hallowell BD; Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA.; Center for Global Health, College of Public Health, University of Georgia, Athens, Georgia, USA., Castellanos ME; Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA.; Center for Global Health, College of Public Health, University of Georgia, Athens, Georgia, USA., Lu P; Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China., Liu Q; Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China., Whalen CC; Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA.; Center for Global Health, College of Public Health, University of Georgia, Athens, Georgia, USA., Zhu L; Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2021 Nov 02; Vol. 73 (9), pp. e3446-e3455.
DOI:	10.1093/cid/ciaa1146
Abstrakt:	Background: There are large knowledge gaps on the transmission dynamics of Mycobacterium tuberculosis in settings where both tuberculosis and human immunodeficiency virus (HIV) are endemic. We aimed to assess the infectiousness of tuberculosis patients coinfected with HIV. Methods: We systematically searched for studies of contacts of both HIV-positive and HIV-negative tuberculosis index cases. Our primary outcome was Mycobacterium tuberculosis infection in contacts. Data on sputum smear and lung cavitation status of index cases were extracted from each study to assess effect modification. Secondary outcomes included prevalent tuberculosis and HIV in contacts of HIV-positive and HIV-negative index cases. Results: Of 5255 original citations identified, 32 studies met inclusion criteria, including 25 studies investigating M. tuberculosis infection (Nparticipants = 36 893), 13 on tuberculosis (Nparticipants = 18 853), and 12 on HIV positivity (Nparticipants = 18 424). Risk of M. tuberculosis infection was lower in contacts of HIV-positive index cases (odds ratio [OR], 0.67, 95% confidence interval [CI], .58-.77) but was heterogeneous (I2 = 75.1%). Two factors modified this relationship: the lung cavitary status of the index case and immunosuppression (measured through CD4 counts or HIV or acquired immunodeficiency syndrome diagnoses) among index people living with HIV. Rates of HIV were consistently higher in contacts of coinfected index cases (OR, 4.9; 95% CI, 3.0-8.0). This was modified by whether the study was in sub-Saharan Africa (OR, 2.8; 95% CI, 1.6-4.9) or in another global region (OR, 9.8; 95% CI, 5.9-16.3). Conclusions: Tuberculosis patients coinfected with HIV are less infectious than HIV-uninfected cases when they have severe immunosuppression or paucibacillary disease. Contacts of coinfected index cases are almost 5 times more likely to also have HIV. (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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