Assessment of the Association between HIV/AIDS and Multi-Drug Resistance Tuberculosis: A Systemic Review with Meta-analysis.

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Addis Ababa University


Back ground: Human immunodeficiency virus, multi-drug resistant tuberculosis and extensive drug resistant tuberculosis are emerging as major challenges facing tuberculosis control programs worldwide (especially in Asia and Africa). The challenge is not only from a public health point of view but also in the context of global economy, especially in the absence of treatment for multi-drug resistant tuberculosis at national-level programs in developing countries. The association between multi-drug resistant tuberculosis and Human Immunodeficiency Virus infection has not yet been fully investigated and the results of the studies so far conducted were not consistent. Objective: The aim of this study was to summarize the evidence on the association between multi-drug resistant tuberculosis and HIV infection through a systematic review of existing literature. Methods: Literature based systemic review of observational studies was conducted. Original studies providing Mycobacterium tuberculosis resistance data stratified by Human Immunodeficiency Virus status were identified using data bases such as MEDLINE/PUBMED, Google Scholar and HINARI. The descriptions of original studies were made using frequency and forest plot. Publication bias was assessed using Funnel plot graphically and Egger weighted and Begg rank regression tests statistically. Heterogeneity across studies was checked using Cochrane Q test statistic and I. Pool risk estimates of multi-drug resistance tuberculosis and sub-grouping analysis were computed to analyze associations with Human Immunodeficiency Virus status. Results: Random effects meta-analysis of all the 24 observational studies showed that Human Immunodeficiency Virus infection was associated with an increased risk of multi-drug resistant tuberculosis (summery odds ratio 1.24; 95%, 1.04 – 1.43). Subgroup analyses showed that effect estimates were higher for primary multi-drug resistance tuberculosis and in population based studies. Conclusions: Human Immunodeficiency Virus infection is positively and significantly associated with an increased risk of multi-drug resistant tuberculosis regardless of study base and multi-drug resistant tuberculosis type. There should be strong collaboration between HumanImmunodeficiency Virus and tuberculosis control programs.



HIV/AIDS,Tuberculosis,Multi-Drug Resistance