PMID- 34239668
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220721
IS  - 1936-2625 (Electronic)
IS  - 1936-2625 (Linking)
VI  - 14
IP  - 6
DP  - 2021
TI  - Association of CD4 T cell count and optimal timing of antiretroviral therapy 
      initiation with immune reconstitution inflammatory syndrome and all-cause 
      mortality for HIV-infected adults with newly diagnosed pulmonary tuberculosis: a 
      systematic review and meta-analysis.
PG  - 670-679
AB  - AIMS: CD4 T cell count and optimal timing of antiretroviral therapy (ART) during 
      tuberculosis (TB) treatment are challenging. We conducted a meta-analysis to 
      assess the association of CD4 T cell count and timing of ART initiation with 
      immune reconstitution inflammatory syndrome (IRIS) and all-cause mortality of 
      patients co-infected with HIV/TB. METHODS: We conducted an electronic search of 
      clinical studies dated from January 1980 to December 2019 in PubMed and EMBASE. 
      Randomized, controlled trials evaluating low-base CD4 T cell count (< 50 
      cells/muL) versus high-base CD4 T cell count (>/= 50 cells/muL), and/or early ART 
      initiation (1 to 28 days after starting TB treatment) versus delayed ART 
      initiation (>/= 28 days after starting TB treatment) were included. The primary 
      endpoints were all-cause mortality and TB-related immune reconstitution 
      inflammatory syndrome (IRIS-TB). The risk ratio (RR) was calculated as a measure 
      of intervention effect. Mantel-Haenszel method was used to estimate the RR. 
      RESULTS: Ten trials (n = 5226) were conducted in North America, Africa, and Asia. 
      We found that low-baseline CD4 T cell count increased the incidence of 
      TB-associated IRIS (RR, 1.47; 95% CI, 1.24-1.75; I(2) = 58%) and all-cause 
      mortality (RR, 2.42; 95% CI, 1.71-3.42; I(2) = 41%) compared with high baseline 
      CD4 T cell count, and early ART initiation increased the incidence of 
      TB-associated IRIS compared with delayed ART initiation (RR, 1.80; 95% CI, 
      1.57-2.07; I(2) = 74%). However, early ART initiation did not reduce all-cause 
      mortality (RR, 0.91; 95% CI, 0.74-1.12; I(2) = 49%) compared with delayed ART 
      initiation. CONCLUSIONS: The present study demonstrates that low-baseline CD4 T 
      cell count (< 50 cells/muL) in patients co-infected with TB-HIV increases the 
      incidence of TB-associated IRIS and all-cause mortality. Early ART initiation (</= 
      28 days) in patients co-infected with TB-HIV increases the incidence of 
      TB-associated IRIS. However, evidence is insufficient to refute or support a 
      survival benefit conferred by the comparison between early ART initiation (</= 28 
      days) and delayed ART initiation.
CI  - IJCEP Copyright (c) 2021.
FAU - Li, Lifang
AU  - Li L
AD  - Department of Respiratory Medicine, The Second Hospital of Shanxi Medical 
      University Taiyuan 030001, Shanxi Province, P. R. China.
FAU - Li, Jianqiang
AU  - Li J
AD  - Department of Respiratory Medicine, The Second Hospital of Shanxi Medical 
      University Taiyuan 030001, Shanxi Province, P. R. China.
FAU - Chai, Chunwei
AU  - Chai C
AD  - Department of Internal Medicine, The Fourth People's Hospital of Shanxi Medical 
      University Taiyuan 030001, Shanxi Province, P. R. China.
FAU - Liu, Tanzhen
AU  - Liu T
AD  - Department of Respiratory Medicine, The Second Hospital of Shanxi Medical 
      University Taiyuan 030001, Shanxi Province, P. R. China.
FAU - Li, Pingping
AU  - Li P
AD  - Department of Respiratory Medicine, The Second Hospital of Shanxi Medical 
      University Taiyuan 030001, Shanxi Province, P. R. China.
FAU - Qu, Mengrui
AU  - Qu M
AD  - Department of Respiratory Medicine, The Second Hospital of Shanxi Medical 
      University Taiyuan 030001, Shanxi Province, P. R. China.
FAU - Zhao, Hui
AU  - Zhao H
AD  - Department of Respiratory Medicine, The Second Hospital of Shanxi Medical 
      University Taiyuan 030001, Shanxi Province, P. R. China.
LA  - eng
GR  - P30 AI042853/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Review
DEP - 20210615
PL  - United States
TA  - Int J Clin Exp Pathol
JT  - International journal of clinical and experimental pathology
JID - 101480565
PMC - PMC8255206
OTO - NOTNLM
OT  - CD4 T cell count
OT  - antiretroviral therapy
OT  - human immunodeficiency virus
OT  - immune reconstitution inflammatory syndrome
OT  - tuberculosis
COIS- None.
EDAT- 2021/07/10 06:00
MHDA- 2021/07/10 06:01
PMCR- 2021/06/15
CRDT- 2021/07/09 06:58
PHST- 2020/09/07 00:00 [received]
PHST- 2021/03/07 00:00 [accepted]
PHST- 2021/07/09 06:58 [entrez]
PHST- 2021/07/10 06:00 [pubmed]
PHST- 2021/07/10 06:01 [medline]
PHST- 2021/06/15 00:00 [pmc-release]
PST - epublish
SO  - Int J Clin Exp Pathol. 2021 Jun 15;14(6):670-679. eCollection 2021.