Prisoners co-infected with tuberculosis and HIV: A systematic review: A

Chantal L. Edge*, Emma J. King, Kate Dolan, Martin McKee

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

11 Citations (Scopus)

Abstract

Introduction: Almost from the beginning of the HIV epidemic in 1981, an association with tuberculosis (TB) was recognized. This association between HIV and TB co-infection has been particularly evident amongst prisoners. However, despite this, few studies of TB in prisons have stratified results by HIV status. Given the high prevalence of HIV-positive persons and TB-infected persons in prisons and the documented risk of TB in those infected with HIV, it is of interest to determine how co-infection varies amongst prison populations worldwide. For this reason we have undertaken a systematic review of studies of co-infected prisoners to determine the incidence and/or prevalence of HIV/TB co-infection in prisons, as well as outcomes in this group, measured as treatment success or death. Methods: A literature search was undertaken using the online databases PubMed, Embase, IBSS, Scopus, Web of Science, Global Health and CINAHL Plus. No restrictions were set on language or publication date for article retrieval, with articles included if indexed up to 18 October 2015. A total of 1975 non-duplicate papers were identified. For treatment and outcome data all eligible papers were appraised for inclusion; for incidence/prevalence estimates papers published prior to 2000 were excluded from full text review. After full text appraisal, 46 papers were selected for inclusion in the review, 41 for incidence/prevalence estimates and nine for outcomes data, with four papers providing evidence for both outcomes and prevalence/incidence. Results: Very few studies estimated the incidence of TB in HIV positive prisoners, with most simply reporting prevalence of co-infection. Co-infection is rarely explicitly measured, with studies simply reporting HIV status in prisoners with TB, or a cross-sectional survey of TB prevalence amongst prisoners with HIV. Estimates of co-infection prevalence ranged from 2.4 to 73.1% and relative risks for one, given the other, ranged from 2.0 to 10.75, although some studies reported no significant association between HIV and TB. Few studies provided a comparison with the risk of co-infection in the general population. Conclusions: Prisoners infected with HIV are at high risk of developing TB. However, the magnitude of risk varies between different prisons and countries. There is little evidence on treatment outcomes in co-infected prisoners, and the existing evidence is conflicting in regards to HIV status influence on prisoner treatment outcomes. PROSPERO Number: CRD42016034068

Original languageEnglish
Article number20960
JournalJournal of the International AIDS Society
Volume19
Issue number1
DOIs
Publication statusPublished - Jan 2016
Externally publishedYes

Bibliographical note

Funding Information:
We are grateful to Chris Beyrer for encouraging us to write this paper. This paper is part of a larger project on HIV and related infections in prisoners and was supported by grants to the Center for Public Health and Human Rights at Johns Hopkins Bloomberg School of Public Health from: the National Institute on Drug Abuse; the Open Society Foundations; the United Nations Population Fund; MACAIDS; the Bill and Melinda Gates Foundation; and the Johns Hopkins University Center for AIDS Research, a National Institute of Health (NIH)-funded programme 1P30AI094189.

Publisher Copyright:
© 2016 Edge C L et al; licensee International AIDS Society.

Keywords

  • co-infection
  • HIV
  • incidence
  • outcomes
  • prevalence
  • prisoners
  • TB
  • tuberculosis

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