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

Title: Same-day antiretroviral therapy initiation in people living with HIV who have tuberculosis symptoms: a systematic review
Authors: Burke, RM
Rickman, HM
Singh, V
Kalua, T
Labhardt, N
Hosseinipour, M
Wilkinson, RJ
MacPherson, P
Item Type: Journal Article
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 summarised 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 eight months was 31% when everyone with tuberculosis symptoms had ART deferred, and 44% when algorithm was changed so that some people with tuberculosis symptoms could start same-day ART. Conclusions Although tuberculosissymptoms 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 maximise benefits of sameday ART.
Issue Date: Jan-2022
Date of Acceptance: 13-Aug-2021
DOI: 10.1111/hiv.13169
ISSN: 1464-2662
Publisher: Wiley
Start Page: 4
End Page: 15
Journal / Book Title: HIV Medicine
Volume: 23
Issue: 1
Copyright Statement: © 2021 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Wellcome Trust
Wellcome Trust
Funder's Grant Number: 104803/Z/14/Z
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
same-day ART
tuberculosis screening
same-day ART
tuberculosis screening
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2021-09-15
Appears in Collections:Department of Infectious Diseases
Faculty of Medicine

This item is licensed under a Creative Commons License Creative Commons