Same-day antiretroviral therapy initiation for people living with HIV who have tuberculosis symptoms: A systematic review
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.
Authors
Burke RM, Rickman HM, Singh V, Kalua T, Labhardt ND, Hosseinipour M, Wilkinson RJ, MacPherson P
Year
2021
Topics
- Population(s)
- General HIV+ population
- Prevention, Engagement and Care Cascade
- Engagement and Care Cascade
- Engagement and Care Cascade
- Treatment
- Co-infections
- Tuberculosis
- Health Systems
- Delivery arrangements
