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Antiretroviral Therapy in HIV Infected Children with Tuberculosis: A Systematic Review.

Sulis, Giorgia MD; Amadasi, Silvia MD; Odone, Anna MD, MPH; Penazzato, Martina MD; Matteelli, Alberto MD
Pediatric Infectious Disease Journal: Post Acceptance: September 7, 2017
doi: 10.1097/INF.0000000000001784
HIV Reports: PDF Only

Background: Tuberculosis is the major cause of mortality in HIV-infected children globally. Current guidelines about the management of antiretroviral therapy in children with tuberculosis are based on a limited number of non-randomized studies involving small numbers of participants. The aim of the study was to systematically retrieve and critically appraise available evidence on the efficacy and safety of different antiretroviral regimens in children with HIV infection who are receiving treatment for active tuberculosis.

Methods: We conducted a systematic review of the literature according to PRISMA guidelines. Records were retrieved through March 2016 from Medline, Embase and manual screening of key conference proceedings. Four specific research questions assessing available treatment options were defined.

Results: Although four independent searches were conducted (one for each PICO question), results were elaborated and interpreted together due to significant overlap among the retrieved records. Six observational studies were selected for qualitative synthesis, while meta-analysis could not be performed.

Conclusion: Evidence for optimal treatment options for HIV/tuberculosis co-infected children is limited. As the global community strives to reach the fast-track HIV treatment targets and eliminate childhood tuberculosis deaths, it must ensure that co-infected children are included in key treatment studies and expand this neglected but crucial area of research.

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