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Same‐day antiretroviral therapy initiation for people living with HIV who have tuberculosis symptoms: a systematic review

Burke, Rachael M., Rickman, Hannah M., Singh, Vindi, Kalua, Thokozani, Labhardt, Niklaus D., Hosseinipour, Mina, Wilkinson, Robert J. and MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613 (2022) 'Same‐day antiretroviral therapy initiation for people living with HIV who have tuberculosis symptoms: a systematic review'. HIV Medicine, Vol 23, Issue 1, pp. 43-15.

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Abstract

Objectives: Tuberculosis symptoms are very common among people living with HIV (PLHIV) initiating antiretroviral therapy (ART), are not specific for tuberculosis disease and may result in delayed ART start. The risks and benefits of same‐day ART initiation in PLHIV with tuberculosis symptoms are unknown. Methods: We systematically reviewed nine databases on 12 March 2020 to identify studies that investigated same‐day ART initiation among PLHIV with tuberculosis symptoms and reported both their approach to TB screening and clinical outcomes. We extracted and summarized data about TB screening, numbers of people starting same‐day ART and outcomes. Results: We included four studies. Two studies deferred ART for everyone with any tuberculosis symptoms (one or more of cough, fever, night sweats or weight loss) and substantial numbers of people had deferred ART start (28% and 39% did not start same‐day ART). Two studies permitted some people with tuberculosis symptoms to start same‐day ART, and fewer people deferred ART (2% and 16% did not start same‐day). Two of the four studies were conducted sequentially; proven viral load suppression at 8 months was 31% when everyone with tuberculosis symptoms had ART deferred, and 44% when the algorithm was changed so that some people with tuberculosis symptoms could start same‐day ART. Conclusions: Although tuberculosis symptoms are very common in people starting ART, there is insufficient evidence about whether presence of tuberculosis symptoms should lead to ART start being deferred or not. Research to inform clear guidelines would help to maximise the benefits of same‐day ART.

Item Type: Article
Subjects: QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 268.5 Antiviral agents (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.1111/hiv.13169
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 16 Sep 2021 09:58
Last Modified: 03 Feb 2022 16:45
URI: https://archive.lstmed.ac.uk/id/eprint/18939

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