Same‐day antiretroviral therapy initiation for people living with HIV who have tuberculosis symptoms: a systematic review

Burke, R. M., Rickman, H. M., Singh, V., Kalua, T., Labhardt, N. D., Hosseinipour, M., Wilkinson, R. J. and MacPherson, P. (2022) Same‐day antiretroviral therapy initiation for people living with HIV who have tuberculosis symptoms: a systematic review. HIV Medicine, 23(1), pp. 4-15. (doi: 10.1111/hiv.13169) (PMID:34528368)

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.

• Item Type: Articles
• Additional Information: This work was funded by WHO Global HIV, Hepatitis and STI programme. RMB and PM are funded by Wellcome (203905/Z/16/Z and 206575/Z/17/Z, respectively). RJW is supported in part by Wellcome (104803, 203135). RJW was supported by the Francis Crick Institute which receives core funding from Cancer Research UK (FC0010218), the UK Medical Research Council (FC0010218) and Wellcome (FC0010218).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Burke, R. M., Rickman, H. M., Singh, V., Kalua, T., Labhardt, N. D., Hosseinipour, M., Wilkinson, R. J., and MacPherson, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: HIV Medicine
• Publisher: Wiley
• ISSN: 1464-2662
• ISSN (Online): 1468-1293
• Published Online: 15 September 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in HIV Medicine 23(1):4-15
• Publisher Policy: Reproduced under a Creative Commons licence