Imperial College London
Professor Robert Wilkinson

ProfessorRobertWilkinson

Faculty of Medicine, Department of Infectious Disease

Professor in Infectious Diseases
 
 
 
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Contact

 

r.j.wilkinson Website

 
 
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Location

 

Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Burke:2021:10.1002/jia2.25772,
author = {Burke, RM and Rickman, HM and Singh, V and Corbett, EL and Ayles, H and Jahn, A and Hosseinipour, M and Wilkinson, RJ and MacPherson, P},
doi = {10.1002/jia2.25772},
journal = {Journal of the International AIDS Society},
pages = {1--16},
title = {What is the optimum time to start antiretroviral therapy in people with HIV and tuberculosis coinfection? A systematic review and meta-analysis},
url = {http://dx.doi.org/10.1002/jia2.25772},
volume = {24},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: HIV and tuberculosis are frequently diagnosed concurrently. In March 2021, World Health Organization recommended that antiretroviral therapy (ART) should be started within two weeks of tuberculosis treatment start, at any CD4 count. We aimed to assess whether earlier ART improved outcomes in people with newly diagnosed HIV and tuberculosis.Methods: We did a systematic review by searching nine database for for trials that compared earlier ART to later ART initiation in people with HIV and tuberculosis. We included studied published from database inception to 12 March 2021. We compared ART within four weeks vs. ART more than four weeks after TB treatment, and ART within two weeks vs. ART between two and eight weeks, and stratified analysis by CD4 count. The main outcome was death; secondary outcomes included IRIS and AIDS-defining events. We used  random effects meta-analysis to pool effect estimates.Results:  2468 abstracts were screened, from which we identified nine trials.  Among people with all CD4 counts, there was no difference in mortality by earlier ART (≤ 4 week) vs. later ART (> 4 week) (risk difference [RD] 0%; 95% confidence interval [CI] -2% to +1%).  Among people with CD4 count ≤50 cells/mm3, earlier ART (≤4 weeks) reduced risk of death (RD -6%; -10% to -1%).  Among people with all CD4 counts earlier ART (≤4 weeks)  increased the risk of IRIS (RD +6%, 95% CI +2% to +10%) and reduced the incidence of AIDS defining events (RD -2%, 95% CI -4% to 0%). Results were similar when trials were restricted to the five trials which permitted comparison of ART within two weeks to ART between two and eight weeks.Discussion: Earlier ART did not alter risk of death overall among people living with HIV who had TB disease.  Trials were conducted between 2004 and 2014, before recommendations to treat HIV at any CD4 count or to rapidly start ART in people without TB.  No trials included children or pregnant women.  No trials included integrase in
AU  - Burke,RM
AU  - Rickman,HM
AU  - Singh,V
AU  - Corbett,EL
AU  - Ayles,H
AU  - Jahn,A
AU  - Hosseinipour,M
AU  - Wilkinson,RJ
AU  - MacPherson,P
DO  - 10.1002/jia2.25772
EP  - 16
PY  - 2021///
SN  - 1758-2652
SP  - 1
TI  - What is the optimum time to start antiretroviral therapy in people with HIV and tuberculosis coinfection? A systematic review and meta-analysis
T2  - Journal of the International AIDS Society
UR  - http://dx.doi.org/10.1002/jia2.25772
UR  - https://onlinelibrary.wiley.com/doi/10.1002/jia2.25772
UR  - http://hdl.handle.net/10044/1/90274
VL  - 24
ER  -
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