Earlier initiation of antiretroviral therapy prevents active tuberculosis in people living with HIV – summary of findings and evaluation of the quality of the evidence

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WHO Policy on Collaborative TB/HIV Activities: Guidelines for National Programmes and Other Stakeholders. Geneva: World Health Organization; 2012.

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WHO Policy on Collaborative TB/HIV Activities: Guidelines for National Programmes and Other Stakeholders.

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Annex 1Earlier initiation of antiretroviral therapy prevents active tuberculosis in people living with HIV – summary of findings and evaluation of the quality of the evidence

PICO question: Can earlier initiation of antiretroviral therapy (ART) at higher CD4 counts (>350 cells/mm³) be used to prevent active tuberculosis in people living with HIV? Should antiretroviral therapy be used to prevent active tuberculosis?

Population: adults and adolescents living with HIV

Intervention: ART at CD4 counts >350 cells/mm³

Comparison: no ART or ART deferred until CD4 counts ≤350 cells/mm³

Outcomes: TB incidence rate

1. Outcomes of interest

2. Literature search strategy and information retrieval

3. GRADE profile

4. Risk and benefits assessment

References

1.: Miranda A, et al. Impact of antiretroviral therapy on the incidence of tuberculosis: the Brazilian experience, 1995–2001. PLoS ONE. 2007;2(9):e826. [PMC free article: PMC1952142] [PubMed: 17786198]
2.: Santoro-Lopes G, et al. Reduced risk of tuberculosis among Brazilian patients with advanced human immunodeficiency virus infection treated with highly active antiretroviral therapy. Clinical Infectious Diseases. 2002 Feb 15;34(4):543–6. [PubMed: 11797184]
3.: Girardi E, et al. Impact of combination antiretroviral therapy on the risk of tuberculosis among persons with HIV infection. AIDS. 2000;14(13):1985–1991. [PubMed: 10997404]
4.: Lawn SD, et al. Short-term and long-term risk of tuberculosis associated with CD4 cell recovery during antiretroviral therapy in South Africa. AIDS. 2009;23(13):1717–1725. [PMC free article: PMC3801095] [PubMed: 19461502]
5.: Egger M, editor. Outcomes of ART in resource-limited and industrialized countries. 14th Conference on retroviruses and opportunistic infections (CROI 2007); Los Angeles, USA. CROI.
6.: Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach, 2010 revision. Geneva: World Health Organization; 2010. [PubMed: 23741771]
7.: Badri M, Wilson D, Wood R. Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: a cohort study. Lancet. 2002;359(9323):2059–2064. [PubMed: 12086758]
8.: Del Amo J, Hernan M., (HIV-CASUAL). Combined antiretroviral therapy and the incidence of tuberculosis among HIV-positive individuals in high-income countries. personal communication. 2011.
9.: Severe P, et al. Early versus standard antiretroviral therapy for HIV-infected adults in Haiti. New England Journal of Medicine. 2010;363(3):257–265. [PMC free article: PMC3676927] [PubMed: 20647201]
10.: Cohen MS, et al. Prevention of HIV-1 Infection with Early Antiretroviral Therapy. New England Journal of Medicine. 2011;365(6):493–505. [PMC free article: PMC3200068] [PubMed: 21767103]
11.: Golub JE, et al. The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil. AIDS. 2007;21(11):1441–1418. [PMC free article: PMC3063947] [PubMed: 17589190]
12.: Golub JE, et al. Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort. AIDS. 2009;23(5):631–636. [PMC free article: PMC3063949] [PubMed: 19525621]
13.: Girardi E, et al. Incidence of Tuberculosis among HIV-infected patients receiving highly active antiretroviral therapy in Europe and North America. Clinical Infectious Diseases. 2005;41(12):1772–1782. [PubMed: 16288403]
14.: Jones JL, et al. HIV-associated tuberculosis in the era of highly active antiretroviral therapy. The Adult/Adolescent Spectrum of HIV Disease Group. International Journal of Tuberculosis and Lung Disease. 2000;4(11):1026–1031. [PubMed: 11092714]
15.: Lau B, Zhang J., (NA-ACCORD). Incidence of Tuberculosis after HAART Initiation in HIV-infected persons. personal communication. 2011.
16.: Ledergerber B, et al. AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss HIV Cohort Study. JAMA. 1999;282(23):2220–2226. [PubMed: 10605973]
17.: Moreno S, et al. Incidence and risk factors for tuberculosis in HIV-positive subjects by HAART status. International Journal of Tuberculosis and Lung Disease. 2008;12(12):1393–1400. [PubMed: 19017448]

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WHO Policy on Collaborative TB/HIV Activities: Guidelines for National Programmes and Other Stakeholders. Geneva: World Health Organization; 2012. Annex 1, Earlier initiation of antiretroviral therapy prevents active tuberculosis in people living with HIV – summary of findings and evaluation of the quality of the evidence.
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