Prevalence, Clinical Features, and Predictors of Adrenal Insufficiency in Adults With Tuberculosis or HIV: A Systematic Review and Meta-analysis

Author:

Kibirige Davis12ORCID,Owarwo Noela3,Kyazze Andrew Peter4,Morgan Bethan5,Olum Ronald6ORCID,Bongomin Felix7ORCID,Andia-Biraro Irene4

Affiliation:

1. Department of Medicine, Uganda Martyrs Hospital Lubaga , Kampala , Uganda

2. Non-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit , Entebbe , Uganda

3. Infectious Diseases Institute, College of Health Sciences, Makerere University , Kampala , Uganda

4. Department of Medicine, College of Health Sciences, Makerere University , Kampala , Uganda

5. Education and Research Centre, Wythenshawe Hospital , Manchester , UK

6. School of Public Health, College of Health Sciences, Makerere University , Kampala , Uganda

7. Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University , Gulu , Uganda

Abstract

Abstract Background Despite the high frequency of adrenal insufficiency (AI) in patients with tuberculosis or HIV, its diagnosis is often missed or delayed resulting in increased mortality. This systematic review and meta-analysis aimed to document the prevalence, significant clinical features, and predictors of AI in adult patients with tuberculosis or HIV. Methods We systematically searched databases (Medline, Embase, CINAHL, Cochrane Library, and Africa Journal Online) for published studies on AI in adult patients with tuberculosis or HIV. The pooled prevalence of AI was determined by a random-effect model meta-analysis. A narrative review was used to describe the significant clinical features and predictors of AI in adult patients with tuberculosis or HIV. Results A total of 46 studies involving 4044 adults were included: 1599 with tuberculosis and 2445 with HIV. The pooled prevalence of AI was 33% (95% CI, 22%–45%; I2 = 97.7%, P < .001) in participants with tuberculosis and 28% (95% CI, 18%–38%; I2 = 98.9%, P < .001) in those with HIV. Presentation with multidrug-resistant tuberculosis, abdominal pain, salt craving, myalgia, increased severity and duration of tuberculosis disease, and the absence of nausea predicted AI in participants with tuberculosis in 4 studies. Cytomegalovirus antigenemia positivity, rifampicin therapy, and eosinophilia >3% predicted AI in participants with HIV in 2 studies. Conclusions AI is relatively common in adults with tuberculosis or HIV. Its timely screening, diagnosis, and management in patients with these 2 conditions should be encouraged to avert mortality.

Publisher

Oxford University Press (OUP)

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