Incident Tuberculosis and Risk Factors Among HIV-infected Children in Tanzania

Overview

Journal AIDS

Specialty Infectious Diseases

Date 2013 Jan 25

PMID 23343909

Citations 33

Authors

Nan Li

Karim P Manji

Donna Spiegelman

Aisa Muya

Ramadhani S Mwiru

Enju Liu

Guerino Chalamilla

Wafaie W Fawzi

Christopher Duggan

Affiliations

Soon will be listed here.

Abstract

Objective: To describe the burden of pediatric tuberculosis (TB) in a HIV-infected population and explore the demographic and clinical factors associated with the occurrence of pediatric TB.

Design: Longitudinal analysis of a cohort of HIV-infected children.

Methods: The endpoint of the study was clinically diagnosed TB. Cox proportional hazard regression was used to explore the predictors of incident TB among HIV-infected children under age 15 years after enrollment into the HIV program.

Results: The cohort comprised of 5040 children [median age: 5 years, interquartile range (IQR) 1-9 years]. During a median follow-up of 0.8 (IQR 0.1-2.5) years, 376 out of 5040 children met the case definition for TB. The overall incidence of TB was 5.2/100 person-years. In multivariate analyses, older age at enrollment [relative risk (RR) 1.7, 95%, confidence interval (CI) 1.5-1.8], severe wasting (RR 1.8, 95% CI 1.3-2.5), severe immune suppression (RR 2.6, 95% CI 1.8-3.8), anemia (RR 1.4, 95% CI 1.0-1.9) and WHO stage IV (RR 4.5, 95% CI 2.4-8.5) were all independently associated with a higher risk of TB. In addition, the use of antiretroviral drugs for more than 180 days reduced the risk of TB by 70% (RR 0.3, 95% CI 0.2-0.4).

Conclusions: Antiretroviral therapy (ART) use is strongly associated with a reduced risk of tuberculosis among HIV-infected children, and should therefore be included in HIV care and treatment programs. Trials of interventions designed to improve the nutritional and hematologic status of these children should also be performed.

Citing Articles

Incidence of tuberculosis and its predictors among children on antiretroviral therapy in Amhara Region, Ethiopia: a multicentre institution-based retrospective follow-up study.

Mekonnen G, Legesse B, Baye F, Wondie W BMJ Open. 2025; 15(2):e093808.

PMID: 39947830 PMC: 11831273. DOI: 10.1136/bmjopen-2024-093808.

Incidence and predictors of tuberculosis among HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis.

Kassaw A, Asferie W, Azmeraw M, Kefale D, Kerebih G, Mekonnen G PLoS One. 2024; 19(7):e0306651.

PMID: 38968268 PMC: 11226042. DOI: 10.1371/journal.pone.0306651.

Undernutrition as a risk factor for tuberculosis disease.

Franco J, Bongaerts B, Metzendorf M, Risso A, Guo Y, Pena Silva L Cochrane Database Syst Rev. 2024; 6:CD015890.

PMID: 38860538 PMC: 11165671. DOI: 10.1002/14651858.CD015890.pub2.

Incidence rate of tuberculosis among HIV infected children in Ethiopia: systematic review and meta-analysis.

Girma D, Abita Z, Shifera N, Arage M, Abate B, Alie M BMC Pediatr. 2024; 24(1):363.

PMID: 38790006 PMC: 11127285. DOI: 10.1186/s12887-024-04819-7.

Incidence and predictors of tuberculosis among children receiving antiretroviral therapy in the Wolaita Zone: A retrospective cohort study.

Tekese D, Dawit D, Hawulte B, Mohammed H, Asefa F, Oljira L PLoS One. 2023; 18(9):e0291502.

PMID: 37733689 PMC: 10513190. DOI: 10.1371/journal.pone.0291502.

References

Fishman J, Saraf-Lavi E, Narita M, Hollender E, Ramsinghani R, Ashkin D . Pulmonary tuberculosis in AIDS patients: transient chest radiographic worsening after initiation of antiretroviral therapy. AJR Am J Roentgenol. 2000; 174(1):43-9. DOI: 10.2214/ajr.174.1.1740043. View

Harries A, Hargreaves N, Graham S, Mwansambo C, Kazembe P, Broadhead R . Childhood tuberculosis in Malawi: nationwide case-finding and treatment outcomes. Int J Tuberc Lung Dis. 2002; 6(5):424-31. View

Isanaka S, Mugusi F, Urassa W, Willett W, Bosch R, Villamor E . Iron deficiency and anemia predict mortality in patients with tuberculosis. J Nutr. 2011; 142(2):350-7. PMC: 3260062. DOI: 10.3945/jn.111.144287. View

Lawn S, Churchyard G . Epidemiology of HIV-associated tuberculosis. Curr Opin HIV AIDS. 2009; 4(4):325-33. PMC: 4233405. DOI: 10.1097/COH.0b013e32832c7d61. View

Perez Mato S, Van Dyke R . Pulmonary infections in children with HIV infection. Semin Respir Infect. 2002; 17(1):33-46. DOI: 10.1053/srin.2002.31685. View

Marais B, Hesseling A, Gie R, Schaaf H, Enarson D, Beyers N . The bacteriologic yield in children with intrathoracic tuberculosis. Clin Infect Dis. 2006; 42(8):e69-71. DOI: 10.1086/502652. View

Edmonds A, Lusiama J, Napravnik S, Kitetele F, Van Rie A, Behets F . Anti-retroviral therapy reduces incident tuberculosis in HIV-infected children. Int J Epidemiol. 2009; 38(6):1612-21. PMC: 2790346. DOI: 10.1093/ije/dyp208. View

Hesseling A, Westra A, Werschkull H, Donald P, Beyers N, Hussey G . Outcome of HIV infected children with culture confirmed tuberculosis. Arch Dis Child. 2005; 90(11):1171-4. PMC: 1720190. DOI: 10.1136/adc.2004.070466. View

Durrleman S, Simon R . Flexible regression models with cubic splines. Stat Med. 1989; 8(5):551-61. DOI: 10.1002/sim.4780080504. View

10.

van Lettow M, Fawzi W, Semba R . Triple trouble: the role of malnutrition in tuberculosis and human immunodeficiency virus co-infection. Nutr Rev. 2003; 61(3):81-90. DOI: 10.1301/nr.2003.marr.81-90. View

11.

Eamranond P, Jaramillo E . Tuberculosis in children: reassessing the need for improved diagnosis in global control strategies. Int J Tuberc Lung Dis. 2001; 5(7):594-603. View

12.

Kumar A, Upadhyay S, Kumari G . Clinical Presentation, treatment outcome and survival among the HIV infected children with culture confirmed tuberculosis. Curr HIV Res. 2007; 5(5):499-504. DOI: 10.2174/157016207781662434. View

13.

Fraser A, Longnecker M, Lawlor D . Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999-2004. Gastroenterology. 2007; 133(6):1814-20. PMC: 2180388. DOI: 10.1053/j.gastro.2007.08.077. View

14.

Kouakoussui A, Fassinou P, Anaky M, Elenga N, Laguide R, Wemin M . Respiratory manifestations in HIV-infected children pre- and post-HAART in Abidjan, the Ivory Coast. Paediatr Respir Rev. 2004; 5(4):311-5. DOI: 10.1016/j.prrv.2004.07.008. View

15.

McNally L, Jeena P, Gajee K, Thula S, Sturm A, Cassol S . Effect of age, polymicrobial disease, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive study. Lancet. 2007; 369(9571):1440-1451. DOI: 10.1016/S0140-6736(07)60670-9. View

16.

Braitstein P, Nyandiko W, Vreeman R, Wools-Kaloustian K, Sang E, Musick B . The clinical burden of tuberculosis among human immunodeficiency virus-infected children in Western Kenya and the impact of combination antiretroviral treatment. Pediatr Infect Dis J. 2009; 28(7):626-32. DOI: 10.1097/INF.0b013e31819665c5. View

17.

Lawn S, Bekker L, Middelkoop K, Myer L, Wood R . Impact of HIV infection on the epidemiology of tuberculosis in a peri-urban community in South Africa: the need for age-specific interventions. Clin Infect Dis. 2006; 42(7):1040-7. DOI: 10.1086/501018. View

18.

Kahabuka F, Plasschaert A, Vant Hof M . Prevalence of teeth with untreated dental trauma among nursery and primary school pupils in Dar es Salaam, Tanzania. Dent Traumatol. 2001; 17(3):109-13. DOI: 10.1034/j.1600-9657.2001.017003109.x. View

19.

Marais B, Gie R, Schaaf H, Beyers N, Donald P, Starke J . Childhood pulmonary tuberculosis: old wisdom and new challenges. Am J Respir Crit Care Med. 2006; 173(10):1078-90. DOI: 10.1164/rccm.200511-1809SO. View

20.

Wisaksana R, Sumantri R, Indrati A, Zwitser A, Jusuf H, de Mast Q . Anemia and iron homeostasis in a cohort of HIV-infected patients in Indonesia. BMC Infect Dis. 2011; 11:213. PMC: 3199780. DOI: 10.1186/1471-2334-11-213. View