Treatment Outcomes and Predictors of Multidrug- Resistant Tuberculosis among HIV-Coinfected Patients: A Systematic Review and Meta-Analysis

Abstract

Multidrug-resistant tuberculosis (MDR TB) and human immunodeficiency virus (HIV) coinfection is complicated, has high toxicity, and is associated with a higher risk of death. This is a comprehensive review and meta-analysis that aimed to pool and summarise the treatment outcomes and their predictors in coinfected people. Eight electronic databases and additional resources were searched through August 2026 in accordance with PRISMA guidelines. A total of 1698 records were identified, of which 30 studies met the eligibility criteria. Treatment outcomes and similar adjusted estimates from predictors were synthesised using a random-effects model. The overall treatment success rate was 56.9% and differed markedly between adults (49.9%) and children (83.4%). The percentages of adult mortality and lost to follow-up were 38.0% and 16.1%, respectively, whereas they were 11.4% and 3.9% for children. Human immunodeficiency virus coinfection was associated with higher mortality (hazard ratio = 2·35), and those not using antiretroviral therapy (ART) had a significantly higher risk of death than those using ART. Viral load was independently associated with death (R = 2.12) and was present in detectable amounts in each death. Through multivariate analysis, anaemia, undernutrition scores, diabetes, substance use scores, pulmonary fibrosis and right-ventricular dysfunction were found to be predictors of adverse outcomes. Antiretroviral therapy, viral suppression, use of fluoroquinolones, use of bedaquiline and optimal immunovirological response, on the other hand, were protective. To achieve a higher success rate and prolong life, integrated services that include immediate ARVs, viral load monitoring, nutrition, management of comorbid conditions, and effective all-oral combination therapy are therefore vital.