student research day - Case Western Reserve University School of ...

Mary I. Huang
Effects of Tuberculosis on the Survival of Patients with Human Immunodeficiency Virus: A Meta-analysis
Mary I. Huang, Dr. Christopher Whalen & Canaan Baer
Epidemiology Department
Case Western Reserve University, School of Medicine
BACKGROUND: Most experts agree that HIV accelerates the progression of TB; however, controversy exists
regarding the contribution of TB to mortality in patients with HIV. Although many studies indicate that TB
accelerates HIV mortality, there are others that show no effect. To date, no comprehensive review of these studies
has been performed. OBJECTIVE: To provide a comprehensive relative risk of death in HIV patients co-infected
with TB compared to HIV patients without TB. METHODS: 120 studies with the following pubmed MESH search
criteria were included in the initial screening: AIDS-related opportunistic infections, HIV infections/complications,
tuberculosis, cohort studies, tuberculosis/mortality, HIV infections/mortality, and mortality. 57 additional studies
were included through a citation review of relevant articles, with a total of 177 studies screened. 160 studies were
excluded because they did not involve patients who are HIV+; separate patients with and without TB infection;
provide survival data; define TB by smear, culture, clinical, and/or other criteria; and/or had a longitudinal study
design or cross-sectional design with a standardized mortality ratio. A total of 11 studies were included in the
primary analysis. RESULTS: The overall estimate of risk based on univariate analyses was 1.46 (1.30-1.63),
indicating a 50% increase in the risk of death associated with TB. Estimates were insignificant for heterogeneity,
and did not change with the more conservative random effects analysis. CONCLUSIONS: Based on the results of
this meta-analysis, it appears that TB can accelerate the progression of HIV. When interpreted in the light of the
effect of immune activation on HIV disease progression, TB may intensify immune activation that enhances viral
replication. Further analysis will be performed on the effect, if any, of AIDS, CD4, opportunistic infections, and comorbidities
on survival.
Supported by the National Institutes of Health: T32 Training Program in Pulmonary Host Defense, Inflammation,
and Innate Immunity, NIH T32-HL083823 •John E. Fogarty International Center: AIDS International Training and
Research Program, TW-00011. •Infectious Disease Society of America: IDSA Medical Scholarship
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