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Background <p>Tuberculosis (TB) is a global problem affecting large numbers of workers exposed to respirable crystalline silica. Both silicosis and exposure to silica without silicosis increase the risk of active TB. While some studies have suggested that silicotuberculosis (silicosis plus TB) or silica exposure on its own are associated with unsuccessful TB treatment outcomes, the evidence is inconsistent. This systematic review and meta-analysis aimed to compare TB treatment outcomes in individuals with silicotuberculosis to those with TB alone, and similarly in those with TB plus silica exposure to those with TB alone.</p> Methods <p>We conducted a systematic review of randomized and nonrandomized trials, and cohort and case-control studies published 1970–2024. Studies were sought which investigated TB treatment outcomes for silicotuberculosis or silica exposure alone via PubMed, Web of Science and Scopus. We conducted risk of bias assessments using ROBINS-E for observational studies of TB treatment (silicosis or silica as the “exposure”) and ROB 2 for randomized trials of different TB drug regimens. GRADE was used to assess overall certainty of evidence.</p> Results <p>Seven studies met the inclusion criteria, all restricted to comparing silicotuberculosis with TB alone or different drug regimens among those with silicotuberculosis. High/very high risk of bias or “some concerns” were noted in six – due to confounding, loss to follow-up, missing data, and/or concerns about exposure or outcome measurement. The pooled odds ratio (OR) for treatment failure/delayed conversion for individuals with silicotuberculosis versus those with TB alone was 1.79 (95% CI 0.54, 5.99; <i>N</i> = 4, very low certainty); for mortality OR 2.45 (95% CI 0.58, 10.39; <i>N</i> = 2, very low certainty); and for TB recurrence OR 1.20 (95% CI 0.01, 134.89; <i>N</i> = 2, very low certainty). The relative risk ratio of recurrence for use of a six versus eight-month TB treatment regimen was 3.29 (95% CI: 0.77, 14.15; <i>N</i> = 1, very low certainty).</p> Conclusions <p>The effect estimates among individuals with silicotuberculosis tended towards unfavourable TB treatment outcomes, including higher mortality. However, the evidence base is sparse and suffers from high risk of bias. Accordingly, these findings should be treated with caution. High-quality studies of both silicotuberculosis and silica exposure without silicosis are long overdue to fill this important evidentiary gap.</p>

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Effectiveness of tuberculosis treatment in individuals exposed to silica or with silicosis: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Meckie Achayo,
  • David Rees,
  • Nandi Siegfried,
  • Rodney Ehrlich

摘要

Background

Tuberculosis (TB) is a global problem affecting large numbers of workers exposed to respirable crystalline silica. Both silicosis and exposure to silica without silicosis increase the risk of active TB. While some studies have suggested that silicotuberculosis (silicosis plus TB) or silica exposure on its own are associated with unsuccessful TB treatment outcomes, the evidence is inconsistent. This systematic review and meta-analysis aimed to compare TB treatment outcomes in individuals with silicotuberculosis to those with TB alone, and similarly in those with TB plus silica exposure to those with TB alone.

Methods

We conducted a systematic review of randomized and nonrandomized trials, and cohort and case-control studies published 1970–2024. Studies were sought which investigated TB treatment outcomes for silicotuberculosis or silica exposure alone via PubMed, Web of Science and Scopus. We conducted risk of bias assessments using ROBINS-E for observational studies of TB treatment (silicosis or silica as the “exposure”) and ROB 2 for randomized trials of different TB drug regimens. GRADE was used to assess overall certainty of evidence.

Results

Seven studies met the inclusion criteria, all restricted to comparing silicotuberculosis with TB alone or different drug regimens among those with silicotuberculosis. High/very high risk of bias or “some concerns” were noted in six – due to confounding, loss to follow-up, missing data, and/or concerns about exposure or outcome measurement. The pooled odds ratio (OR) for treatment failure/delayed conversion for individuals with silicotuberculosis versus those with TB alone was 1.79 (95% CI 0.54, 5.99; N = 4, very low certainty); for mortality OR 2.45 (95% CI 0.58, 10.39; N = 2, very low certainty); and for TB recurrence OR 1.20 (95% CI 0.01, 134.89; N = 2, very low certainty). The relative risk ratio of recurrence for use of a six versus eight-month TB treatment regimen was 3.29 (95% CI: 0.77, 14.15; N = 1, very low certainty).

Conclusions

The effect estimates among individuals with silicotuberculosis tended towards unfavourable TB treatment outcomes, including higher mortality. However, the evidence base is sparse and suffers from high risk of bias. Accordingly, these findings should be treated with caution. High-quality studies of both silicotuberculosis and silica exposure without silicosis are long overdue to fill this important evidentiary gap.