Clinical Features, Endoscopic Features, Histological Features and Outcomes of Gastrointestinal Tuberculosis in People Living with Human Immunodeficiency Virus: A Systematic Review

Purpose Despite a decrease in tuberculosis (TB) incidence worldwide, TB is still the second leading cause of infectious disease deaths. Diagnosing gastrointestinal TB is challenging due to nonspecific symptoms and often negative tests. Our study aims is to analyse the clinical presentations, endoscopic and features, treatment, and outcome of gastrointestinal TB among people living with human immunodeficiency virus (PLHIV). Methods A systematic literature search was conducted on PubMed, ScienceDirect and Ovid SP from inception up until 31st January 2024 to identify relevant case reports. Descriptive statistics were summarized as percentages for categorical variables, and mean ± standard deviation for continuous variables. Binary logistic regression was used to analyse the predictors of mortality. Statistical analysis was conducted using IBM SPSS Statistics 26.0. Results A total of 44 cases from 41 case reports were included in this systematic review. The mean age was 36.23 ± 9.13 where 81.8% were male. Common clinical presentations reported were fever (63.6%), abdominal pain (61.4%) and weight loss (54.5%). Ileum (31.8%) was the most common anatomic location for gastrointestinal TB. The most common endoscopic features was visualized were ulceration (76.7%) followed by polyps (26.7%). The common histological features were granuloma (50%), caseating or necrotizing granuloma (42.1%), and mucosal inflammation (31.6%). 41 cases received anti-tuberculosis therapy while 19 cases underwent surgery. The mortality rate reported was 24.4%. Conclusion The diagnosis of gastrointestinal TB should be considered in PLHIV presenting with constitutional and gastrointestinal symptoms. Subsequently, comprehensive workup should be performed to confirm the diagnosis followed by prompt treatment.