2025/09/05 by Fassikaw Kebede Bizuneh1*, Tsehay Kebede Bizuneh2
paper · doi:10.20372/nadre:17276
Background: Despite the effectiveness of antiretroviral therapy in reducing mortality<br> from opportunistic infections among people living with HIV (PLHIV), tuberculosis<br> (TB) continues to be a significant cause of death, accounting for over one-third<br> of all deaths in this population. In Ethiopia, there is a lack of comprehensive and<br> aggregated data on the national level for TB-associated mortality during co-infection<br> with HIV. Therefore, this systematic review and meta-analysis aimed to estimate TBassociated mortality and identify risk factors for PLHIV in Ethiopia.<br> Methods: We conducted an extensive systematic review of the literature using the<br> Preferred Reporting of Systematic Review and Meta-Analysis (PRISMA) guidelines.<br> More than seven international electronic databases were used to extract 1,196<br> published articles from Scopus, PubMed, MEDLINE, Web of Science, HINARY,<br> Google Scholar, African Journal Online, and manual searching. The pooled mortality<br> proportion of active TB was estimated using a weighted inverse variance randomeffects meta-regression using STATA version-17. The heterogeneity of the articles<br> was evaluated using Cochran’s Q test and I2 statistic test. Subgroup analysis, sensitivity<br> analysis, and Egger’s regression were conducted to investigate publication bias. This<br> systematic review is registered in Prospero with specific No. CRD42024509131.<br> Results: Overall, 22 individual studies were included in the final meta-analysis reports.<br> During the review, a total of 9,856 cases of TB and HIV co-infection were screened<br> and 1,296 deaths were reported. In the final meta-analysis, the pooled TB-associated<br> mortality for PLHIV in Ethiopia was found to be 16.2% (95% CI: 13.0–19.2, I2 = 92.9%,<br> p = 0.001). The subgroup analysis revealed that the Amhara region had a higher<br> proportion of TB-associated mortality, which was reported to be 21.1% (95% CI: 18.1–<br> 28.0, I2 = 84.4%, p = 0.001), compared to studies conducted in Harari and Addis Ababa<br> regions, which had the proportions of 10% (95% CI: 6–13.1%, I2 = 83.38%, p = 0.001)<br> and 8% (95% CI: 1.1–15, I2 = 87.6%, p = 0.001), respectively. During the random-effects<br> meta-regression, factors associated with co-infection of mortality in TB and HIV<br> were identified, including WHO clinical stages III & IV (OR = 3.01, 95% CI: 1.9–4.7),<br> missed co-trimoxazole preventive therapy (CPT) (OR = 1.89, 95% CI: 1.05–3.4), and<br> missed isoniazid preventive therapy (IPT) (OR = 1.8, 95% CI: 1.46–2.3).<br> Conclusion: In Ethiopia, the mortality rate among individuals co-infected with<br> TB/HIV is notably high, with nearly one-fifth (16%) of individuals succumbing<br> during co-infection; this rate is considered to be higher compared to other<br> African countries. Risk factors for death during co-infection were identified; the<br> included studies examined advanced WHO clinical stages IV and III, hemoglobin<br> levels (≤10 mg/dL), missed isoniazid preventive therapy (IPT), and missed<br> cotrimoxazole preventive therapy (CPT) as predictors. To reduce premature<br> deaths, healthcare providers must prioritize active TB screening, ensure timely<br> diagnosis, and provide nutritional counseling in each consecutive visit.<br> Systematic review registration: Trial registration number in Prospero =CRD42024509131