Tuberculosis in people with HIV.

INTRODUCTION

In people infected with both HIV and Mycobacterium tuberculosis, the annual risk of developing active tuberculosis is 5-10% - more than 10 times the rate for people with M tuberculosis infection but without HIV. Untreated, mortality from tuberculosis in people with HIV is likely to be high, and over 5% of people relapse after successful treatment.

METHODS AND OUTCOMES

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of first-line treatments; and of second line treatments for tuberculosis in people infected with HIV? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS

We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS

In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant immunotherapy (with corticosteroids, or Mycobacterium vaccae); antimycobacterial treatment combinations; conventional antituberculous treatment (short courses, long courses, including rifabutin [3 or 5 months], quinolones, or thiacetazone); directly-observed therapy (short course); highly active antiretroviral treatment (early initiation or delayed initiation); rifampicin (3 months or less); secondary prophylaxis with antituberculous treatment; unsupervised treatment.