Incident tuberculosis and risk factors among HIV-infected children in Dar es Salaam, Tanzania
Identifieur interne : 002670 ( Main/Exploration ); précédent : 002669; suivant : 002671Incident tuberculosis and risk factors among HIV-infected children in Dar es Salaam, Tanzania
Auteurs : Nan Li ; Karim P. Manji ; Donna Spiegelman ; Aisa Muya ; Ramadhani S. Mwiru ; Enju Liu ; Guerino Chalamilla ; Wafaie W. Fawzi ; Christopher DugganSource :
- AIDS (London, England) [ 0269-9370 ] ; 2013.
Abstract
To describe the burden of pediatric tuberculosis (TB) in a human immunodeficiency virus (HIV)-infected population and explore the demographic and clinical factors associated with the occurrence of pediatric TB.
Longitudinal analysis of a cohort of HIV-infected children.
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.
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 World Health Organization (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).
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.
Url:
DOI: 10.1097/QAD.0b013e32835ecb24
PubMed: 23343909
PubMed Central: 4742782
Affiliations:
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Mwiru</name></author><author><name sortKey="Liu, Enju" sort="Liu, Enju" uniqKey="Liu E" first="Enju" last="Liu">Enju Liu</name></author><author><name sortKey="Chalamilla, Guerino" sort="Chalamilla, Guerino" uniqKey="Chalamilla G" first="Guerino" last="Chalamilla">Guerino Chalamilla</name></author><author><name sortKey="Fawzi, Wafaie W" sort="Fawzi, Wafaie W" uniqKey="Fawzi W" first="Wafaie W." last="Fawzi">Wafaie W. 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Manji</name></author><author><name sortKey="Spiegelman, Donna" sort="Spiegelman, Donna" uniqKey="Spiegelman D" first="Donna" last="Spiegelman">Donna Spiegelman</name></author><author><name sortKey="Muya, Aisa" sort="Muya, Aisa" uniqKey="Muya A" first="Aisa" last="Muya">Aisa Muya</name></author><author><name sortKey="Mwiru, Ramadhani S" sort="Mwiru, Ramadhani S" uniqKey="Mwiru R" first="Ramadhani S." last="Mwiru">Ramadhani S. Mwiru</name></author><author><name sortKey="Liu, Enju" sort="Liu, Enju" uniqKey="Liu E" first="Enju" last="Liu">Enju Liu</name></author><author><name sortKey="Chalamilla, Guerino" sort="Chalamilla, Guerino" uniqKey="Chalamilla G" first="Guerino" last="Chalamilla">Guerino Chalamilla</name></author><author><name sortKey="Fawzi, Wafaie W" sort="Fawzi, Wafaie W" uniqKey="Fawzi W" first="Wafaie W." last="Fawzi">Wafaie W. Fawzi</name></author><author><name sortKey="Duggan, Christopher" sort="Duggan, Christopher" uniqKey="Duggan C" first="Christopher" last="Duggan">Christopher Duggan</name></author></analytic><series><title level="j">AIDS (London, England)</title><idno type="ISSN">0269-9370</idno><idno type="eISSN">1473-5571</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">To describe the burden of pediatric tuberculosis (TB) in a human immunodeficiency virus (HIV)-infected population and explore the demographic and clinical factors associated with the occurrence of pediatric TB.</p></sec><sec id="S2"><title>Design</title><p id="P2">Longitudinal analysis of a cohort of HIV-infected children.</p></sec><sec id="S3"><title>Methods</title><p id="P3">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.</p></sec><sec id="S4"><title>Results</title><p id="P4">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 World Health Organization (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).</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">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.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Chalamilla, Guerino" sort="Chalamilla, Guerino" uniqKey="Chalamilla G" first="Guerino" last="Chalamilla">Guerino Chalamilla</name><name sortKey="Duggan, Christopher" sort="Duggan, Christopher" uniqKey="Duggan C" first="Christopher" last="Duggan">Christopher Duggan</name><name sortKey="Fawzi, Wafaie W" sort="Fawzi, Wafaie W" uniqKey="Fawzi W" first="Wafaie W." last="Fawzi">Wafaie W. Fawzi</name><name sortKey="Li, Nan" sort="Li, Nan" uniqKey="Li N" first="Nan" last="Li">Nan Li</name><name sortKey="Liu, Enju" sort="Liu, Enju" uniqKey="Liu E" first="Enju" last="Liu">Enju Liu</name><name sortKey="Manji, Karim P" sort="Manji, Karim P" uniqKey="Manji K" first="Karim P." last="Manji">Karim P. Manji</name><name sortKey="Muya, Aisa" sort="Muya, Aisa" uniqKey="Muya A" first="Aisa" last="Muya">Aisa Muya</name><name sortKey="Mwiru, Ramadhani S" sort="Mwiru, Ramadhani S" uniqKey="Mwiru R" first="Ramadhani S." last="Mwiru">Ramadhani S. Mwiru</name><name sortKey="Spiegelman, Donna" sort="Spiegelman, Donna" uniqKey="Spiegelman D" first="Donna" last="Spiegelman">Donna Spiegelman</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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