HIV as A Prognostic Factor for Tuberculosis Relapse: A Systematic Review and Meta-Analysis

Aim: The systematic review objective is determine the magnitude of the association between HIV infection and TB relapse. Background: Relapse refers to tuberculosis (TB) cases that have been treated and declared cured, or that has received complete treatment and is once again diagnosed with an episode of TB. Materials and methods: Cohort-type studies that applied one or more genotyping methods and characterized the serological HIV status of patients were selected. Medline, Embase, BVS, and SciELO databases were used, along with Google and Google Scholar search engines, electronic journals in the Sinab network, grey literature, and bibliographical references from selected studies. Meta-analyses of subgroups were constructed according to the genotyping method, TB prevalence, and relapse definition. Risk of bias was evaluated and a sensitivity analysis was performed. OR estimators were established with and without studies that contributed the highest levels of heterogeneity. Results: Eleven studies with 8941 patients were included. HIV (+) patients show 1.8 times greater risk than HIV (-) patients of presenting global relapse OR 1.78 [1.34, 2.38]. Regarding endogenous relapse, HIV is influential only in low prevalence zones OR 2.09 [1.03, 4.27], while for exogenous relapse, it is influential in high prevalence zones OR 4.42 [1.56, 12.57]. Conclusion: HIV is a prognostic factor for TB relapse. This relation is influenced by prevalence.