Conceived and designed the experiments: LG QJ. Analyzed the data: LG FZ XL QJ. Contributed reagents/materials/analysis tools: LG FZ XL. Wrote the paper: LG FZ QJ.
The authors have declared that no competing interests exist.
TB and HIV co-epidemic is a major public health problem in many parts of the world, particularly in developing counties. We aimed to summarize the prevalence of TB and HIV co-infection in mainland China, using meta-analysis based on systematic review of published articles.
We systematically reviewed published studies, from the MEDLINE and Chinese BioMedical Literature Databases, on the prevalence of HIV infection among TB patients and on the prevalence of TB among HIV/AIDS population until 15 April 2010, and quantitatively summarized the estimates using meta-analysis.
In total, 29 studies were included in this review, with consistently homogeneous results. TB patients, for whom the summary prevalence of HIV infection was 0.9% (0.6%–1.4%) in mainland China, were found to be a potential target population for HIV screening. The prevalence of TB among HIV/AIDS population was 7.2% (4.2%–12.3%), but this was much higher when the analyses were restricted to AIDS patients (22.8%). Significantly higher prevalence was observed for males and hospital-based studies.
Our analyses indicated that the prevalence of HIV/TB co-infection in China deserves special attention, screening of TB among HIV/AIDS populations should be attached more importance, which would be much more helpful for treatment of both diseases.
Mycobecterium tuberculosis (TB) and human immune deficiency virus (HIV) infections are two major public health problems in many parts of the world, particularly in many developing counties
The prevalence of HIV and TB within mainland China is high and the convergence of these two infectious diseases is increasingly and significantly endangering human health
Studies addressing the TB and HIV co-infection were identified by searching for articles in the MEDLINE database and Chinese BioMedical Literature Database until 15 April 2010
Cross-sectional or cohort studies addressing the prevalence of HIV infection among TB patients or the prevalence of TB among HIV/AIDS population were included. If the study was reported in duplicate, the article published earlier was included. In the included studies, screening of HIV infection was performed by the routine ELISA test and all ELISA positives were confirmed by Western Blot. A diagnosis of TB was made based on the combined evaluation of clinical, radiological, histopathological and laboratory features of the patients in accordance with the protocol established by the National Tuberculosis Prevention and Control Program (2008): sample smears/cultures positive, or sample smears/cultures negative but meet all three of the following clinical criteria (1. symptoms consistent with TB; 2. chest X-ray suggestive of TB; 3. a positive anti-TB Rx response). Review articles, and studies in languages other than English or Chinese, with <50 participants, from the regions of China other than mainland (i.e. TaiWan, HongKong and Macao), where the diagnosis of TB was based on serology methods only, focusing on incidence rates, and addressing specific high risk populations (e.g. studies assessing HIV prevalence among TB patients who were injecting drug users), were excluded.
For all included studies, we extracted the following data from original publications: first author and year of publication; study site, study base (population-based or hospital-based) and subject enrollment time; sample size and age of the participants; prevalence of HIV infection and potential route of infection; diagnosis criteria of TB and methods of differential identification of Mycobacteria in clinical samples. In population-based studies, studied cases were collected from a target population (e.g. from communities or regional hospitals); in hospital-based studies, cases were enrolled from specific hospitals and could not cover any target population. In this review, events of HIV infection and TB were extracted from the studies, if available, and included in tabular presentation. For some studies, events had to be calculated from the reported data.
Meta-analyses on the prevalence of HIV infection among TB patients and the prevalence of TB among HIV/AIDS population were carried out using the Comprehensive Meta-Analysis program (V2.0, Biostat, Englewood, NJ, USA)
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Nineteen studies, from 8 different regions or provinces, addressing HIV prevalence among TB patients are presented in
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This review addressed the status of TB and HIV co-infection in mainland China. Twenty four studies were identified and summarized by meta-analysis. Our results suggest a high prevalence of TB among HIV/AIDS cases, especially among AIDS patients. Screening of TB among HIV/AIDS populations should be attached more importance in China which would be much helpful for treatment of both diseases.
To our knowledge, this is the first study to systematically review the status of TB and HIV co-infection in mainland China. TB and HIV co-infection is well recognized as a major public health problem in woldwide and many investigations have been performed and published from western countries
HIV infection has a long latent period before progression to AIDS, which makes the diagnosis, control and treatment more difficult
Due to the different inclusion criteria, we observed very different TB prevalence among HIV/AIDS population. For the studies performed among only AIDS patients, it was as high as 22.8%. For the studies performed among “HIV infections or AIDS patients”, however, it was only 5.2%. This is consistent with the finding that higher prevalence was observed among hospital-based studies. People with more advanced stages of AIDS are easily infected by TB or have poor capability to control disease development from latent TB infection
The limitations of this study should be kept in mind. First, as positive results are more likely to be published, publication bias cannot be excluded completely, although no major publication bias was observed in the meta-analyses. Second, due to the specific high-risk behaviors for TB and HIV infection, the selection of subjects might make results prone to potential selection bias even as we have excluded two studies performed among prisoners and injecting drug users. Third, most of the included studies (27/29) were published in Chinese, quality of the reports could not be expected as well as the articles from English Journals. For example, not all necessary information, even age and gender of the study population, could be obtained from all included studies. Therefore, relevant stratified analyses (e.g. with respect to the regions or HIV infection routes) could not be performed to disclose more detailed characteristics of the co-infection and its related risk factors
In conclusion, our analyses suggest that it is necessary to attach importance to HIV/TB co-infection in mainland China, especially screening of TB among HIV/AIDS populations should be attached more importance which would be much helpful for treatment of both diseases. To ensure a precise estimate of the epidemic status of co-infection, further large scale or even countrywide studies are needed. Such studies will not only provide more tangible proof in promoting the development of effective strategy for diagnosis and surveillance but are also vital in reducing the prevalence of and in improving the prognosis from both TB and HIV/AIDS.
Prevalence of HIV infection among patients with tuberculosis in mainland China (part 1/2).
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Prevalence of HIV infection among patients with tuberculosis in mainland China (part 2/2).
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Prevalence of tuberculosis among HIV/AIDS population in mainland China (part 1/2).
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Prevalence of tuberculosis among HIV/AIDS population in mainland China (part 2/2).
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List of articles excluded from this study after full-text review.
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We thank Dr. Theresa Redaniel, at University of Bristol, for her kind assistance and comments which lead to important improvements of this manuscript on English writing.