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Harshana A, Goyal M, Chako A, Mahajan R. Prevalence of extrapulmonary tuberculosis among people living with HIV/AIDS in Southeast Asia: a systematic review and meta-analysis. Monaldi Arch Chest Dis 2024. [PMID: 39058016 DOI: 10.4081/monaldi.2024.2899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/30/2024] [Indexed: 07/28/2024] Open
Abstract
The dual burden of human immunodeficiency virus (HIV) and tuberculosis (TB) impacts people living with HIV (PLHIV) coinfected with TB. Although some primary studies have been reported on the burden of extrapulmonary TB (EPTB) among PLHIV in Southeast Asia (SEA), there is no systematic review or meta-analysis that attempts to summarize the available literature. Therefore, this review aims to summarize the prevalence of EPTB/HIV co-infection in SEA using meta-analysis based on a systematic review of published articles and gray literature. A comprehensive 3-stage methodology was adopted to conduct a thorough literature search, encompassing both published and gray literature. Data sources such as MEDLINE and Web of Science were searched for articles reporting data from SEA between 2010 and 2022. Findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and were sourced using a predefined search strategy from different databases. The Joanna Briggs Institute prevalence studies checklist was employed for critical appraisal. The meta-analysis of proportions was carried out using the "metaprop" function in R software (version 4.3.1) to generate pooled estimates. Effects were summarized using random-effects models, and sources of heterogeneity were explored through I2, utilizing subgroup and sensitivity analyses. Publication bias was assessed using funnel plots and pertinent statistical tests, including Egger's regression analysis. A total of 474 studies were initially identified in our search. After the removal of duplicates and a meticulous screening process of titles and abstracts, along with the application of exclusion criteria, 22 studies comprising 34,740 PLHIV were included in the final meta-analysis. The summary effect or pooled proportion estimate of EPTB among PLHIV was found to be 18% [95% confidence interval (CI): 15,22; heterogeneity: τ2=0.0056; degrees of freedom=21, p<0.001; I2=99%]. Our study showed that there was a diverse range of prevalence of EPTB among PLHIV in the SEA region, which ranged from 5% (95% CI: 4.0-7.0) in South Korea to 48% (95% CI: 41.0-55.0) in Thailand. Our systematic review and meta-analysis indicate a notably higher prevalence of EPTB among PLHIV. Early diagnosis of EPTB is crucial to mitigating associated morbidity and mortality. Therefore, a thorough medical history and comprehensive physical examination are imperative in assessing PLHIV, aiming to promptly identify and rule out EPTB. After a diligent evaluation, appropriate diagnostic measures and tailored management strategies should be promptly instituted.
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Affiliation(s)
- Amit Harshana
- International Training and Educational Center for Health (ITECH-India), New Delhi, Delhi.
| | - Mohit Goyal
- International Training and Educational Center for Health (ITECH-India), New Delhi, Delhi.
| | | | - Raman Mahajan
- Care and Public Health Research Institute, Maastricht University.
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orwa J, Oduor P, Okelloh D, Gethi D, Agaya J, Okumu A, Wandiga S. Comparison of logistic regression with regularized machine learning methods for the prediction of tuberculosis disease in people living with HIV: cross-sectional hospital-based study in Kisumu County, Kenya. RESEARCH SQUARE 2023:rs.3.rs-3354948. [PMID: 37790564 PMCID: PMC10543507 DOI: 10.21203/rs.3.rs-3354948/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Tuberculosis (TB) is a major public health concern, particularly among people living with the Human immunodeficiency Virus (PLWH). Accurate prediction of TB disease in this population is crucial for early diagnosis and effective treatment. Logistic regression and regularized machine learning methods have been used to predict TB, but their comparative performance in HIV patients remains unclear. The study aims to compare the predictive performance of logistic regression with that of regularized machine learning methods for TB disease in HIV patients. Methods Retrospective analysis of data from HIV patients diagnosed with TB in three hospitals in Kisumu County (JOOTRH, Kisumu sub-county hospital, Lumumba health center) between [dates]. Logistic regression, Lasso, Ridge, Elastic net regression were used to develop predictive models for TB disease. Model performance was evaluated using accuracy, and area under the receiver operating characteristic curve (AUC-ROC). Results Of the 927 PLWH included in the study, 107 (12.6%) were diagnosed with TB. Being in WHO disease stage III/IV (aOR: 7.13; 95%CI: 3.86-13.33) and having a cough in the last 4 weeks (aOR: 2.34;95%CI: 1.43-3.89) were significant associated with the TB. Logistic regression achieved accuracy of 0.868, and AUC-ROC of 0.744. Elastic net regression also showed good predictive performance with accuracy, and AUC-ROC values of 0.874 and 0.762, respectively. Conclusions Our results suggest that logistic regression, Lasso, Ridge regression, and Elastic net can all be effective methods for predicting TB disease in HIV patients. These findings may have important implications for the development of accurate and reliable models for TB prediction in HIV patients.
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Affiliation(s)
- James orwa
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Patience Oduor
- Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda
| | - Douglas Okelloh
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Dickson Gethi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Janet Agaya
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Albert Okumu
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Steve Wandiga
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome-An Extempore Game of Misfiring with Defense Arsenals. Pathogens 2023; 12:pathogens12020210. [PMID: 36839482 PMCID: PMC9964757 DOI: 10.3390/pathogens12020210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
The lethal combination involving TB and HIV, known as "syndemic" diseases, synergistically act upon one another to magnify the disease burden. Individuals on anti-retroviral therapy (ART) are at risk of developing TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). The underlying inflammatory complication includes the rapid restoration of immune responses following ART, eventually leading to exaggerated inflammatory responses to MTB antigens. TB-IRIS continues to be a cause of morbidity and mortality among HIV/TB coinfected patients initiating ART, and although a significant quantum of knowledge has been acquired on the pathogenesis of IRIS, the underlying pathomechanisms and identification of a sensitive and specific diagnostic marker still remain a grey area of investigation. Here, we reviewed the latest research developments into IRIS immunopathogenesis, and outlined the modalities to prevent and manage strategies for better clinical and diagnostic outcomes for IRIS.
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Brown CS, Smith CJ, Breen RAM, Ormerod LP, Mittal R, Fisk M, Milburn HJ, Price NM, Bothamley GH, Lipman MCI. Determinants of treatment-related paradoxical reactions during anti-tuberculosis therapy: a case control study. BMC Infect Dis 2016; 16:479. [PMID: 27600661 PMCID: PMC5013570 DOI: 10.1186/s12879-016-1816-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inflammatory response following initial improvement with anti-tuberculosis (TB) treatment has been termed a paradoxical reaction (PR). HIV co-infection is a recognised risk, yet little is known about other predictors of PR, although some biochemical markers have appeared predictive. We report our findings in an ethnically diverse population of HIV-infected and uninfected adults. METHODS Prospective and retrospective clinical and laboratory data were collected on TB patients seen between January 1999-December 2008 at four UK centres selected to represent a wide ethnic and socio-economic mix of TB patients. Data on ethnicity and HIV status were obtained for all individuals. The associations between other potential risk factors and PR were assessed in a nested case-control study. All PR cases were matched two-to-one to controls by calendar time and centre. RESULTS Of 1817 TB patients, 82 (4.5 %, 95 % CI 3.6-5.5 %) were identified as having a PR event. The frequency of PR was 14.4 % (18/125; 95 % CI 8.2-20.6 %) and 3.8 % (64/1692; 2.9-4.7) for HIV-positive and HIV-negative individuals respectively. There were no differences observed in PR frequency according to ethnicity, although the site was more likely to be pulmonary in those of black and white ethnicity, and lymph node disease in those of Asian ethnicity. In multivariate analysis of the case-control cohort, HIV-positive patients had five times the odds of developing PR (aOR = 5.05; 95 % CI 1.28-19.85, p = 0.028), whilst other immunosuppression e.g. diabetes, significantly reduced the odds of PR (aOR = 0.01; 0.00-0.27, p = 0.002). Patients with positive TB culture had higher odds of developing PR (aOR = 6.87; 1.31-36.04, p = 0.045) compared to those with a negative culture or those in whom no material was sent for culture. Peripheral lymph node disease increased the odds of a PR over 60-fold 4(9.60-431.25, p < 0.001). CONCLUSION HIV was strongly associated with PR. The increased potential for PR in people with culture positive TB suggests that host mycobacterial burden might be relevant. The increased risk with TB lymphadenitis may in part arise from the visibility of clinical signs at this site. Non-HIV immunosuppression may have a protective effect. This study highlights the difficulties in predicting PR using routinely available demographic details, clinical symptoms or biochemical markers.
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Affiliation(s)
- Colin Stewart Brown
- Hospital for Tropical Diseases, University College London Hospitals Foundation Trust, 235 Euston Road, London, NW1 2BU, UK.,UCL Division of Infection and Immunity, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Colette Joanne Smith
- Royal Free Campus, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | | | | | - Rahul Mittal
- Royal Blackburn Hospital, Blackburn, Lancs, BB2 3LR, UK
| | - Marie Fisk
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Heather June Milburn
- Guy's and St Thomas' Hospital NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Nicholas Martin Price
- Guy's and St Thomas' Hospital NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | | | - Marc Caeroos Isaac Lipman
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK. .,UCL Respiratory, Division of Medicine, University College London, Rowland Hill Street, London, NW3 2PF, UK.
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Tan HY, Yong YK, Shankar EM, Paukovics G, Ellegård R, Larsson M, Kamarulzaman A, French MA, Crowe SM. Aberrant Inflammasome Activation Characterizes Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome. THE JOURNAL OF IMMUNOLOGY 2016; 196:4052-63. [DOI: 10.4049/jimmunol.1502203] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/13/2016] [Indexed: 12/31/2022]
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Plasma interleukin-18 levels are a biomarker of innate immune responses that predict and characterize tuberculosis-associated immune reconstitution inflammatory syndrome. AIDS 2015; 29:421-31. [PMID: 25565499 DOI: 10.1097/qad.0000000000000557] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is a substantial problem in HIV/TB coinfected patients commencing antiretroviral therapy (ART). The immunopathogenesis of TB-IRIS includes increased production of proinflammatory chemokines and cytokines, including interleukin-18, which is a signature cytokine of the nucleotide-binding domain and leucine-rich repeat pyrin containing protein-3 inflammasome. We compared plasma levels of interleukin-18 and other biomarkers of monocyte/macrophage activation in the prediction and characterization of TB-IRIS. METHODS Biomarkers were assayed pre-ART and during TB-IRIS, or equivalent time-point, in a case-control study of Malaysian HIV patients with paradoxical or unmasking TB-IRIS (n = 15), TB no IRIS (n = 14), and no TB or IRIS (n = 15). Findings for interleukin-18 were verified in another cohort of patients with paradoxical TB-IRIS (n = 26) and their controls (n = 22) from India. RESULTS Interleukin-18 was higher in TB-IRIS patients pre-ART and during the event in both Malaysian patients (P < 0.0001) and Indian patients (P < 0.01). CXCL10 was higher pre-ART (P < 0.001), mainly in paradoxical TB-IRIS patients, and during TB-IRIS (P < 0.001), whereas CXCL8 was only higher during TB-IRIS (P < 0.001). Soluble(s) CD14 was increased in all patients with HIV/TB coinfection pre-ART and during TB-IRIS or equivalent time-point, compared with patients without TB. In contrast, interferon-γ was lower before and during TB-IRIS. By receiver operating curve analysis, CXCL10, and/or interleukin-18 pre-ART were predictive of TB-IRIS. CONCLUSION Plasma interleukin-18 levels pre-ART are candidate biomarkers for predicting paradoxical and unmasking TB-IRIS and should be investigated for risk stratification and elucidation of disease pathogenesis.
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