2017

2017, Issue 12

One  updated  review is available in Issue 12, of the Cochrane Database of Systematic Reviews

 Updated Review 

Larvivorous fish for preventing malaria transmission  (Walshe DP, Garner P, Adeel AA, Pyke GH, Burkot TR)

This review was first published in December 2013 and it has now been updated by Deirdre Walshe and colleagues.  The aim of the review is to evaluate whether introducing fish that eat mosquito larvae and pupae into water sources, will decrease the adult Anopheles mosquito population and thus the number of people infected with Plasmodium parasites. As in the first version of the review, the authors did not find any studies reporting on the primary outcomes of the review: malaria infection in nearby communities, entomological inoculation rate, or adult Anopheles density. A secondary analysis to examine the effects of introducing larvivorous fish on the density and presence of anopheline larvae and pupae in community water sources, found 15 small studies conducted in a variety of settings in different countries, but all studies were at high risk of bias and insufficient to determine any consistent effects on the density of Anopheles larvae and pupae. The authors conclude that there is insufficient evidence to support investing in larvivorous fish interventions without further reliable research. It is also unclear is whether this question is worth pursuing, as potential effects almost inevitably will be marginal given the large numbers of water bodies usually present in areas where malaria-transmitting Anopheles lay eggs, and some authors have raised the possibility that larvivorous fish may harm indigenous fish and frog species.

2017, Issue 11

One new protocol and one new review are available in Issue 11, of the Cochrane Database of Systematic Reviews

New Protocol

Linezolid for drug-resistant tuberculosis  (Singh B, Cocker D, Ryan H, Sloan D)

New Review

Interventions to increase tuberculosis case detection at primary healthcare or community-level services (Mhimbira FA, Cuevas LE, Dacombe R, Mkopi A, Sinclair D)

In this new review , Francis  Mhimbira and colleagues examine the effects of different strategies to increase tuberculosis (TB) case detection through improved  access  to TB diagnosis at primary healthcare or community-level services. These strategies may increase TB case detection by  identifying people with early TB who are not yet sufficiently unwell to seek care, or people with advanced TB who present late to health services, when the disease is already severe.  The review includes 9 cluster-randomized trials, one individual randomized trial, and 7 non-randomized controlled studies, all from high TB prevalence areas in Sub-Saharan Africa, Asia and South America. TB outreach screening, using house-to-house visits, sometimes combined with printed information about going to clinic, may increase TB case detection and lower default during treatment, but may have little or no effect on treatment success. There was insufficient evidence to determine if health promotion activities alone (through mass media or education) increase TB case detection, and to determine if sustained improvements in case detection impact on long-term tuberculosis prevalence, as the only study to evaluate this found no effect after four years. The authors conclude that when interventions are used in high-burden settings, active case-finding approaches may increase TB case detection in the short term, but it is unclear from the available evidence if they may improve treatment success and reduce tuberculosis treatment failure, mortality, and default.

2017, Issue 10

One new protocol and one  updated review are available in Issue 10, of the Cochrane Database of Systematic Reviews

New Protocol

Methylene blue for treating malaria  (Calderón M, Weitzel T, Rodriguez MF, Ciapponi A)

Updated Review

Mefloquine for preventing malaria during travel to endemic areas (Tickell-Painter M, Maayan N, Saunders R, Pace C, Sinclair D)

This  review, prepared by Maya Tickell-Painter and colleagues, replaces a previous Cochrane review by Frederique Jacquerioz and Ashley Croft and summarizes evidence on the efficacy and safety of mefloquine used as prophylaxis for malaria in travelers.  Mefloquine is widely used to prevent malaria in travelers and visitors to endemic areas, but there is controversy about its psychological side effects. The review’s inclusion criteria have been broadened to cover non-randomized studies, which can provide useful information regarding the side effect profile of mefloquine. The authors have compared prophylactic mefloquine with placebo, no treatment, or with alternative recommended antimalarial agents (atovaquone-proguanil or doxycycline) and analyzed data from 20 RCTs (11,470 participants), 35 cohort studies (198,493 participants), and 4 large retrospective analyses of health records (800,652 participants). The absolute risk to develop malaria during short-term travel appeared low with all three antimalarial agents tested. Mefloquine was not shown to have more frequent serious side effects than either atovaquone-proguanil or doxycycline, but the quality of evidence was low. There was moderate- and high-certainty evidence that mefloquine use is associated with a range of psychological adverse effects, such as abnormal dreams, anxiety, insomnia, and depressed mood, especially with long-term use.  

2017, Issue 9

Two updated reviews are available in Issue 9, of the Cochrane Database of Systematic Reviews

Updated Reviews

Vitamin A supplements for reducing mother-to-child HIV transmission (Wiysonge CS, Ndze VN, Kongnyuy EJ, Shey MS)

The previous version of this review was published in 2011 and this update, led by Charles Wiysonge , sees some change in co-authors and a reduction in the number of secondary outcomes. The primary outcome has not changed and is the HIV infection status of the child. Vitamin A supplementation given to HIV-positive women during pregnancy and after delivery was suggested as a simple and inexpensive intervention that could potentially be implemented even in the absence of prenatal HIV testing programmes. The review includes 5 trials with approximately 7200 women, conducted in Malawi, South Africa, Tanzania, and Zimbabwe between 1995 and 2005. None of the participants received ART. Women allocated to intervention arms received vitamin A supplements at a variety of doses; the comparison arms received placebo or no intervention. Maternal vitamin A supplementation showed little or no effect on mother-to-child transmission of HIV, and may have some beneficial effect on birthweight by the evidence was low. However, this intervention has largely been superseded by ART which is widely available and effective in preventing vertical transmission, and the authors conclude that further research on the use of vitamin A supplements for this indication may not be warranted. 

Interventions for treating tuberculous pericarditis (Wiysonge CS, Ntsekhe M, Thabane L, Volmink J, Majombozi D, Gumedze F, Pandie S, Mayosi BM)

Charles Wiysonge and his team have prepared this review which is a new edition of the 2002 version. The updated review has new authors, additional trials, and different conclusion compared to the previous published version. Tuberculosis infection of the pericardium surrounding the heart is uncommon but life-threatening; in addition to antituberculous chemotherapy, treatments include corticosteroids, drainage, and surgery.  The review includes 7 trials, all from sub-Saharan Africa, with 1959 participants:  1051/1959 (54%) were HIV-positive. All trials evaluate corticosteroids and one each evaluates colchicine, M. indicus pranii immunotherapy, and open surgical drainage. In HIV-negative people, six trials found that additional steroids may reduce deaths overall, probably reduce deaths caused by pericarditis, and may prevent reaccumulation of fluid in the pericardial space. Open surgical drainage for effusion may reduce repeat pericardiocentesis In HIV-negative people. In the treatment of people living with HIV not on antiretroviral drugs, corticosteroids may reduce constrictive pericarditis and hospitalizations, with little or no effect on deaths. There was insufficient data to draw conclusions on the use of colchicine or Mycobacterium indicus pranii immunotherapy.

2017, Issue 8

Four  new protocols and one updated review  are available in Issue 8, of the Cochrane Database of Systematic Reviews

 New Protocols 

 Updated Review

Moleen Zunza and her colleagues have updated this review, first published in 2009. Isoniazid prophylaxis prevents TB in HIV-negative children but it is not known whether it is also effective in HIV-positive children.  This review evaluates the effects of isoniazid preventive treatment versus placebo in HIV-positive children with no known TB contact on active TB, death, and reported adverse events.  The authors identified 3 trials for inclusion, involving 991 participants below the age of 13 years, from South Africa and Botswana. Most of the children were on antiretroviral therapy (ART) and the median length of follow-up ranged from 5.7 to 34 months. In HIV-positive children not taking ART, isoniazid medication reduced the number of children developing active TB by 69%, and death by 54%. In in HIV-positive children taking ART, there was no benefit or harm taking isoniazid. The number of children with adverse effects was similar in the group receiving isoniazid medication or placebo, with or without taking ART. The authors suggest that any child awaiting ART in a high TB prevalence area, should have isoniazid prophylaxis until the child is virally suppressed and immune reconstituted.

 2017, Issue 7 

Three new protocols  are available in Issue 7, of the Cochrane Database of Systematic Reviews

 New Protocols 

2017, Issue 6 

Two new protocols  are available in Issue 6, of the Cochrane Database of Systematic Reviews

 New Protocols 

2017, Issue 5 

Two new reviews, one updated review and one new protocol are available in Issue 5, of the Cochrane Database of Systematic Reviews

 New Reviews

This new Diagnostic Test Accuracy (DTA) review assesses the accuracy of commercially-available rapid diagnostic tests (RDTs) and their prototypes for detecting typhoid and paratyphoid (enteric) fever in people living in endemic countries. These RDTs are available as alternatives to the current reference standard test of blood or bone marrow culture, or to the widely used Widal Test, but their diagnostic accuracy is unclear. Lalith Wijedoru and his co-authors identified 37 eligible studies with 5080 participants, which evaluated 16 different RDTs.  Most included studies were from Asia, with 5 from sub-Saharan Africa, and evaluated three RDTs and their variants: TUBEX, Typhidot, and the Test-It Typhoid immunochromatographic lateral flow assay.  The authors found that few studies were at a low risk of bias, and that the 3 main RDT tests and variants had moderate diagnostic accuracy, with no evidence of differences between their average sensitivity and specificity. The RDTs evaluated are not sufficiently accurate to replace blood culture as a diagnostic test for enteric fever.

Jennifer Onwumeh, Charles Okwundu and Tamara Kredo in this new review evaluate the effects of IL-2 as an adjunct to antiretroviral therapy (ART) in reducing the morbidity and mortality in HIV-positive adults. IL-2 is a cytokine that regulates the proliferation and differentiation of lymphocytes and may help to boost the immune system, which is harmed by HIV infection, and help in the control of viral replication as well as lead to lower susceptibility to opportunistic infections.  The authors identified 25 trials for inclusion; 11 were conducted in academic centres in the USA and the others in 6 different countries.  IL-2 in combination with ART increased the CD4 cell count in HIV-positive adults, but it did not show any significant benefit in mortality. There were probably no differences in the incidence of opportunistic infections, but there was probably an increase in grade 3 or 4 adverse effects. The findings of this review do not support the use of IL-2 as an adjunct to ART in HIV-positive adults, and the authors conclude that further trials are not justified.

Updated Review 

This update of a Cochrane Review previously published in 2010 assesses the effects of micronutrient supplements for adults living with HIV (excluding pregnant women). Micronutrient deficiencies are common among in HIV+ adults, particularly in low-income settings where the diet may be low in essential vitamins and minerals, and routine supplementation could therefore be beneficial. Marianne Visser and colleagues identified 17 new trials for this update, and the review now includes 33 trials with 10,325 participants. Some trials looked at the effects of taking supplements with multiple micronutrients whereas others looked at supplementation with single vitamins or minerals such as vitamins A and D, zinc, and selenium.  Daily supplements containing multiple vitamins and minerals showed little or no effect on reducing deaths in people living with HIV, and none of the trials of single or dual micronutrient supplements were adequately powered to assess for their effects on mortality or morbidity. The authors conclude that although the available trials have not revealed consistent clinically important benefits, these findings do not mean that an adequate dietary intake for people living with HIV is not important or that micronutrient supplements should be denied to people in whom a deficiency has been clinically demonstrated.

New Protocol 

2017, Issue 3

One new and one updated review are available in Issue 3 of the Cochrane Database of Systematic Reviews

New Review

In this new review, Ingrid van der Heijden and colleagues examine whether group therapy can improve the well-being of adults living with the human immunodeficiency virus (HIV). HIV causes a chronic, life threatening, and often stigmatising disease, which can impact on a person's psychological well-being, and group therapy could help people living with HIV to cope wit the condition, or recover from depression, anxiety, and stress. Group interventions include cognitive behavioural therapy (CBT), and others such as relaxation techniques and stress management, problem solving and coping skills, social or peer support, education and empowerment. The review includes 16 trials conducted in the USA (12 trials), Canada (one trial), Switzerland (one trial), Uganda (one trial), and South Africa (one trial), with a total of 2520 adults living with HIV. Group-based therapy based on CBT showed a small effect on measures of depression, lasting for up to 15 months and little or no effect on measures of anxiety, stress, and coping. Group interventions based on mindfulness were studied in two small trials, and had not demonstrated effects on measures of depression, anxiety or stress. The quality of evidence was overall low, and the authors conclude that existing group interventions have little to no effect in increasing psychological adjustment to living with HIV, and more good quality studies are required.

Updated Review

A new team led by Hannah Ryan has just completed an update of this review, which was first published in 1998, after revising the protocol and altering the outcomes of interest. Some clinicians believe that corticosteroids used in combination with antituberculous drugs can speed up the recovery from TB pleurisy and help to prevent long-term complications, but research findings have been inconsistent and there is some concern regarding the potential adverse effects of corticosteroids, especially in HIV-positive people. The updated review includes 6 trials with 590 participants, conducted in Asia (3 trials), Africa (2 trials), and Europe (1 trial). Two trials were in HIV-negative people, one trial was in HIV-positive people, and three trials did not report HIV status. Corticosteroids may reduce the time to resolution of the symptoms of TB pleurisy and the time to resolution of the pleural effusion on chest X-ray, as well as reduce the risk of having signs of pleural scarring. However, they may increase the risk of adverse events leading to discontinuation of the trial drug. As the risk of disability and long-term illness after TB pleurisy is unclear, research looking at the association between TB pleurisy and lung function impairment would be useful to inform future research into corticosteroids for TB pleurisy.