SynthesisLancet (London, England)2020
Mortality in adults with multidrug-resistant tuberculosis and HIV by antiretroviral therapy and tuberculosis drug use: an individual patient data meta-analysis.
Synthesis in Lancet (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 39 papers, 6 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
39 citing papers in PubMed, 6 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Pooled it
- A systematic review of risk factors for mortality among tuberculosis patients in South Africa.Systematic reviews · 2023Pooled it
- Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment.PloS one · 2023Pooled it
- Genetic variants and their association with phenotypic resistance to bedaquiline inThe Lancet. Microbe · 2021Pooled it
- Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis.PloS one · 2021Pooled it
- Pooled it
- QT prolongation in participants receiving bedaquiline-containing regimens: analysis of data from Phase 3 STREAM Stage 2.IJTLD open · 2026Article
- Severe pre-treatment attrition in the care cascade: clinical outcomes and risk factors among older MDR/RR-TB patients in China.Frontiers in public health · 2026Article
- Magnitude of poor multidrug-resistant tuberculosis treatment outcome among multidrug-resistant tuberculous patients at tertiary hospital, South West Ethiopia.Annals of clinical microbiology and antimicrobials · 2025Article
- Traditional and Short Course Treatment for Multidrug-Resistant Tuberculosis: A Comparative Study in National Referral Centers.Tanaffos · 2025Article
- Trends and treatment outcomes of drug resistant tuberculosis in Limpopo Province, South Africa (2011-2019): A Retrospective Study.PloS one · 2025Article
- Evaluating compliance with quality indicators of HIV and AIDS clinical care and analyzing those associated with mortality in the Democratic Republic of Congo.BMC infectious diseases · 2024Article
- Predicting Treatment Outcomes in Patients with Drug-Resistant Tuberculosis and Human Immunodeficiency Virus Coinfection, Using Supervised Machine Learning Algorithm.Pathogens (Basel, Switzerland) · 2024Article
- Prison as a driver of recent transmissions of multidrug-resistant tuberculosis in Callao, Peru: a cross-sectional study.Lancet regional health. Americas · 2024Article
- Global, regional, and national disease burden and attributable risk factors of HIV/AIDS in older adults aged 70 years and above: a trend analysis based on the Global Burden of Disease study 2019.Epidemiology and infection · 2023Article
- What clinic closure reveals about care for drug-resistant TB: a qualitative study.BMC infectious diseases · 2023Article
- Updated considerations in the diagnosis and management of tuberculosis infection and disease: integrating the latest evidence-based strategies.Expert review of anti-infective therapy · 2023Review
- The estimation of long and short term survival time and associated factors of HIV patients using mixture cure rate models.BMC medical research methodology · 2023Article
- Whole-genome sequencing and transcriptome-characterizedMicrobial genomics · 2023Article
- Mortality rate and associated factors among patients co-infected with drug resistant tuberculosis/HIV at Mulago National Referral Hospital, Uganda, a retrospective cohort study.PLOS global public health · 2023Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
17 authors at 13 institutions in 10 countries.
Funding
Abstract
backgroundHIV-infection is associated with increased mortality during multidrug-resistant tuberculosis treatment, but the extent to which the use of antiretroviral therapy (ART) and anti-tuberculosis medications modify this risk are unclear. Our objective was to evaluate how use of these treatments altered mortality risk in HIV-positive adults with multidrug-resistant tuberculosis.
methodsWe did an individual patient data meta-analysis of adults 18 years or older with confirmed or presumed multidrug-resistant tuberculosis initiating tuberculosis treatment between 1993 and 2016. Data included ART use and anti-tuberculosis medications grouped according to WHO effectiveness categories. The primary analysis compared HIV-positive with HIV-negative patients in terms of death during multidrug-resistant tuberculosis treatment, excluding those lost to follow up, and was stratified by ART use. Analyses used logistic regression after exact matching on country World Bank income classification and drug resistance and propensity-score matching on age, sex, geographic site, year of multidrug-resistant tuberculosis treatment initiation, previous tuberculosis treatment, directly observed therapy, and acid-fast-bacilli smear-positivity to obtain adjusted odds ratios (aORs) and 95% CIs. Secondary analyses were conducted among those with HIV-infection.
findingsWe included 11 920 multidrug-resistant tuberculosis patients. 2997 (25%) were HIV-positive and on ART, 886 (7%) were HIV-positive and not on ART, and 1749 (15%) had extensively drug-resistant tuberculosis. By use of HIV-negative patients as reference, the aOR of death was 2·4 (95% CI 2·0-2·9) for all patients with HIV-infection, 1·8 (1·5-2·2) for HIV-positive patients on ART, and 4·2 (3·0-5·9) for HIV-positive patients with no or unknown ART. Among patients with HIV, use of at least one WHO Group A drug and specific use of moxifloxacin, levofloxacin, bedaquiline, or linezolid were associated with significantly decreased odds of death.
interpretationUse of ART and more effective anti-tuberculosis drugs is associated with lower odds of death among HIV-positive patients with multidrug-resistant tuberculosis. Access to these therapies should be urgently pursued.
fundingAmerican Thoracic Society, Canadian Institutes of Health Research, US Centers for Disease Control and Prevention, European Respiratory Society, Infectious Diseases Society of America.
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