Table 1.
Overview of the Main Studies Reporting on the Prevalence of Tuberculosis and Association With VL Treatment Outcomes in Leishmania donovani-Endemic Countries (1990–2017)
| Ref | Country, Setting (Healthcare Level), Study Period, Study Design |
Study Population Characteristics and Main VL Treatment | TB Diagnosis (Method) | Prevalence, Type, and Timing of TBa | Early Treatment Outcomes (Death, Treatment Failure) | Late Treatment Outcomes: Relapse or Relapse-Free Survival | Comments |
|---|---|---|---|---|---|---|---|
| Ethiopia | |||||||
| [21, 22] | NW Ethiopia University hospital and MSF supported health center (2011–2015). Single-arm pentamidine secondary prophylaxis trial |
74 HIV-infected adults, at high risk of VL relapse; AmBisome 30 mg/kg (±MF); SSG (±PM) |
No information | 6 of 74 (8.2%) no details on type and timing | Relapse: univariate association during and after PM: OR, 1.9 (95% CI, 0.6–6.6); Not retained in multivariate analysis | Also no significant association with relapse-free survival | |
| [23] | NW Ethiopia, MSF supported health center (2/2008–2/2013) Retrospective cohort study |
146 VL-HIV-coinfected adults AmBisome 30 mg/kg (±MF) |
WHO guidelines | 33 of 145 (22%) no details |
Relapse: OR, 1.0 (95% CI, 0.5–2.0) | ||
| [24] | NW Ethiopia, MSF supported health center and district hospital (1/2007–1/2009) Retrospective cohort study |
195 VL-HIV-coinfected patients AmBisome 30 mg/kg |
No information | 58 of 195 (29.7%) no details |
Parasitological failure: no association in multivariate analysis OR, 0.7 (95% CI, 0.2–2.2) | In HIV neg: 7.4% (but 80 of 195 included) |
|
| [25] | NW Ethiopia, MSF supported district hospital (2003–2006) Retrospective cohort study |
Patients not on ART: 161 Patients on ART: 195 First-line treatment: SSG |
No information | No ART: No TB: 64% TB before VL: 25% After VL: 8% Before and after: 2.5% On ART: No TB: 41% TB before VL: 40% After VL: 16% Before and after: 2.6% |
Death: TB at any time (crude association) Pts not on ART: OR, 2.1 (95% CI, 0.5–8.7) Pts on ART: OR, 1.1 (95% CI, 0.5–2.4) |
Relapse: crude OR No ART: TB before VL: 1.3 (95% CI, 0.6–2.9) TB after VL: 0.6 (95% CI, 0.1–2.4) Before and after: 6.3 (95% CI, 1.4–28.0) On ART TB before VL: 1.3 (95% CI, 0.6–2.5) TB after 1.2 (95% CI, 0.5–2.9) Before and after: 3.1 (95% CI, 0.9–10.5) |
Two cases of TB IRIS Adjusted associations not reported |
| [16] | NW Ethiopia University hospital and district hospital (2006–2008) Retrospective cohort study |
Adult VL-HIV-infected patients, x% male SSG or AmBisome 30 mg/kg |
No information | 25 of 92 (27%) no details |
Death or failure: adjusted OR for TB, 4.5 (95% CI, 1.5–13.9) | TB prevalence 6% in HIV-negative patients | |
| India | |||||||
| [13] | MSF supported district hospital, Bihar, India (2007–2012) Retrospective cohort study |
159 VL-HIV-coinfected patients, 83% male AmBisome 20–25 mg/kg |
No information | 9 of 159 (5.7%) no details | Mortality: adjusted OR, 3.9 (95% CI, 1.6–9.5) | Relapse: crude OR: 2.0 (95% CI, 0.5–8.5) Not included in multivariate analysis |
|
| [14] | MSF supported district hospital, Bihar, India (2007–2010) Retrospective cohort study |
55 VL-HIV-coinfected patients AmBisome 20–25 mg/kg, 83% male | No information | 9 of 55 (16%) no details |
Death or treatment failure: significant association in univariate but not in multivariate analysis | Relapse: no significant association in univariate analysis | Death: significant association in univariate analysis (multivariate not done given low number) |
| [15] | MSF supported district hospital, Bihar, India (2012–2014) Retrospective cohort study |
102 VL-HIV-coinfected patients; AmBisome 30 mg/kg + MF 14 days, 75% male | No information | 9 of 102 (8.8%) no details |
Death: adjusted OR, 5.3 (95% CI, 1.6–17.8) | Relapse: borderline significant: crude OR, 9.5 (95% CI, 0.9–97.9) | Relapse or death: adjusted OR, 7.5 (95% CI, 2.5–22.1) |
Abbreviations: ART, antiretroviral therapy; CI, confidence interval; HIV, human immunodeficiency virus; IRIS, immune reconstitution inflammatory syndrome; MF, miltefosine; MSF, Médecins sans Frontières; NW, North-West; PM, paromomycin; Pts, patients; OR, odds ratio; Ref, reference; SSG, sodium stibogluconate; TB, tuberculosis; VL, visceral leishmaniasis; WHO, World Health Organization.
aTiming relative to VL diagnosis: whether the TB diagnosis was before, at the time of, or after the VL diagnosis (eg, during VL treatment).