@article{Burke2021,
abstract = {Background: HIV and tuberculosis are frequently diagnosed concurrently. In March 2021, World Health Organization recommended that antiretroviral therapy (ART) should be started within two weeks of tuberculosis treatment start, at any CD4 count. We assessed whether earlier ART improved outcomes in people with newly diagnosed HIV and tuberculosis. Methods: We did a systematic review by searching nine databases for trials that compared earlier ART to later ART initiation in people with HIV and tuberculosis. We included studies published from database inception to 12 March 2021. We compared ART within four weeks versus ART more than four weeks after TB treatment, and ART within two weeks versus ART between two and eight weeks, and stratified analysis by CD4 count. The main outcome was death; secondary outcomes included IRIS and AIDS-defining events. We pooled effect estimates using random effects meta-analysis. Results and discussion: We screened 2468 abstracts, and identified nine trials. Among people with all CD4 counts, there was no difference in mortality by earlier ART (≤4 week) versus later ART ({\textgreater}4 week) (risk difference [RD] 0{\%}, 95{\%} confidence interval [CI] {\`{A}}2{\%} to +1{\%}). Among people with CD4 count ≤50 cells/mm 3 , earlier ART (≤4 weeks) reduced risk of death (RD {\`{A}}6{\%}, {\`{A}}10{\%} to {\`{A}}1{\%}). Among people with all CD4 counts earlier ART (≤4 weeks) increased the risk of IRIS (RD +6{\%}, 95{\%} CI +2{\%} to +10{\%}) and reduced the incidence of AIDS-defining events (RD {\`{A}}2{\%}, 95{\%} CI {\`{A}}4{\%} to 0{\%}). Results were similar when trials were restricted to the four trials which permitted comparison of ART within two weeks to ART between two and eight weeks. Trials},
author = {Burke, Rachael M and Rickman, Hannah M and Singh, Vindi and Corbett, Elizabeth L and Ayles, Helen and Jahn, Andreas and Hosseinipour, Mina C and Wilkinson, Robert J and MacPherson, Peter},
doi = {10.1002/JIA2.25772},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Burke et al. - 2021 - What is the optimum time to start antiretroviral therapy in people with HIV and tuberculosis coinfection A systema.pdf:pdf},
issn = {1758-2652},
journal = {Journal of the International AIDS Society},
keywords = {HIV,OA,OA{\_}PMC,antiretroviral therapy,fund{\_}not{\_}ack,public health,rapid ART,review,systematic review,tuberculosis},
mendeley-tags = {OA,OA{\_}PMC,fund{\_}not{\_}ack,review},
month = {jul},
number = {7},
pages = {e25772},
pmid = {34289243},
publisher = {John Wiley {\&} Sons, Ltd},
title = {{What is the optimum time to start antiretroviral therapy in people with HIV and tuberculosis coinfection? A systematic review and meta-analysis}},
url = {https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25772 https://onlinelibrary.wiley.com/doi/abs/10.1002/jia2.25772 https://onlinelibrary.wiley.com/doi/10.1002/jia2.25772},
volume = {24},
year = {2021}
}

{"_id":"wpNBuJc5up25o3G85","bibbaseid":"burke-rickman-singh-corbett-ayles-jahn-hosseinipour-wilkinson-etal-whatistheoptimumtimetostartantiretroviraltherapyinpeoplewithhivandtuberculosiscoinfectionasystematicreviewandmetaanalysis-2021","author_short":["Burke, R. M","Rickman, H. M","Singh, V.","Corbett, E. L","Ayles, H.","Jahn, A.","Hosseinipour, M. C","Wilkinson, R. J","MacPherson, P."],"bibdata":{"bibtype":"article","type":"article","abstract":"Background: HIV and tuberculosis are frequently diagnosed concurrently. In March 2021, World Health Organization recommended that antiretroviral therapy (ART) should be started within two weeks of tuberculosis treatment start, at any CD4 count. We assessed whether earlier ART improved outcomes in people with newly diagnosed HIV and tuberculosis. Methods: We did a systematic review by searching nine databases for trials that compared earlier ART to later ART initiation in people with HIV and tuberculosis. We included studies published from database inception to 12 March 2021. We compared ART within four weeks versus ART more than four weeks after TB treatment, and ART within two weeks versus ART between two and eight weeks, and stratified analysis by CD4 count. The main outcome was death; secondary outcomes included IRIS and AIDS-defining events. We pooled effect estimates using random effects meta-analysis. Results and discussion: We screened 2468 abstracts, and identified nine trials. Among people with all CD4 counts, there was no difference in mortality by earlier ART (≤4 week) versus later ART (\\textgreater4 week) (risk difference [RD] 0%, 95% confidence interval [CI] À2% to +1%). Among people with CD4 count ≤50 cells/mm 3 , earlier ART (≤4 weeks) reduced risk of death (RD À6%, À10% to À1%). Among people with all CD4 counts earlier ART (≤4 weeks) increased the risk of IRIS (RD +6%, 95% CI +2% to +10%) and reduced the incidence of AIDS-defining events (RD À2%, 95% CI À4% to 0%). Results were similar when trials were restricted to the four trials which permitted comparison of ART within two weeks to ART between two and eight weeks. Trials","author":[{"propositions":[],"lastnames":["Burke"],"firstnames":["Rachael","M"],"suffixes":[]},{"propositions":[],"lastnames":["Rickman"],"firstnames":["Hannah","M"],"suffixes":[]},{"propositions":[],"lastnames":["Singh"],"firstnames":["Vindi"],"suffixes":[]},{"propositions":[],"lastnames":["Corbett"],"firstnames":["Elizabeth","L"],"suffixes":[]},{"propositions":[],"lastnames":["Ayles"],"firstnames":["Helen"],"suffixes":[]},{"propositions":[],"lastnames":["Jahn"],"firstnames":["Andreas"],"suffixes":[]},{"propositions":[],"lastnames":["Hosseinipour"],"firstnames":["Mina","C"],"suffixes":[]},{"propositions":[],"lastnames":["Wilkinson"],"firstnames":["Robert","J"],"suffixes":[]},{"propositions":[],"lastnames":["MacPherson"],"firstnames":["Peter"],"suffixes":[]}],"doi":"10.1002/JIA2.25772","file":":C$\\$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Burke et al. - 2021 - What is the optimum time to start antiretroviral therapy in people with HIV and tuberculosis coinfection A systema.pdf:pdf","issn":"1758-2652","journal":"Journal of the International AIDS Society","keywords":"HIV,OA,OA_PMC,antiretroviral therapy,fund_not_ack,public health,rapid ART,review,systematic review,tuberculosis","mendeley-tags":"OA,OA_PMC,fund_not_ack,review","month":"jul","number":"7","pages":"e25772","pmid":"34289243","publisher":"John Wiley & Sons, Ltd","title":"What is the optimum time to start antiretroviral therapy in people with HIV and tuberculosis coinfection? A systematic review and meta-analysis","url":"https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25772 https://onlinelibrary.wiley.com/doi/abs/10.1002/jia2.25772 https://onlinelibrary.wiley.com/doi/10.1002/jia2.25772","volume":"24","year":"2021","bibtex":"@article{Burke2021,\r\nabstract = {Background: HIV and tuberculosis are frequently diagnosed concurrently. In March 2021, World Health Organization recommended that antiretroviral therapy (ART) should be started within two weeks of tuberculosis treatment start, at any CD4 count. We assessed whether earlier ART improved outcomes in people with newly diagnosed HIV and tuberculosis. Methods: We did a systematic review by searching nine databases for trials that compared earlier ART to later ART initiation in people with HIV and tuberculosis. We included studies published from database inception to 12 March 2021. We compared ART within four weeks versus ART more than four weeks after TB treatment, and ART within two weeks versus ART between two and eight weeks, and stratified analysis by CD4 count. The main outcome was death; secondary outcomes included IRIS and AIDS-defining events. We pooled effect estimates using random effects meta-analysis. Results and discussion: We screened 2468 abstracts, and identified nine trials. Among people with all CD4 counts, there was no difference in mortality by earlier ART (≤4 week) versus later ART ({\\textgreater}4 week) (risk difference [RD] 0{\\%}, 95{\\%} confidence interval [CI] {\\`{A}}2{\\%} to +1{\\%}). Among people with CD4 count ≤50 cells/mm 3 , earlier ART (≤4 weeks) reduced risk of death (RD {\\`{A}}6{\\%}, {\\`{A}}10{\\%} to {\\`{A}}1{\\%}). Among people with all CD4 counts earlier ART (≤4 weeks) increased the risk of IRIS (RD +6{\\%}, 95{\\%} CI +2{\\%} to +10{\\%}) and reduced the incidence of AIDS-defining events (RD {\\`{A}}2{\\%}, 95{\\%} CI {\\`{A}}4{\\%} to 0{\\%}). Results were similar when trials were restricted to the four trials which permitted comparison of ART within two weeks to ART between two and eight weeks. 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