Incident tuberculosis and risk factors among HIV-infected children in Tanzania

被引:33
|
作者
Li, Nan [1 ]
Manji, Karim P. [2 ]
Spiegelman, Donna [3 ,4 ]
Muya, Aisa [5 ]
Mwiru, Ramadhani S. [6 ]
Liu, Enju [1 ]
Chalamilla, Guerino [5 ]
Fawzi, Wafaie W. [1 ,3 ,6 ]
Duggan, Christopher [7 ]
机构
[1] Harvard Univ, Sch Publ Hlth, Dept Global Hlth & Populat, Boston, MA 02115 USA
[2] Muhimbili Univ Hlth & Allied Sci, Dept Pediat, Dar Es Salaam, Tanzania
[3] Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA
[4] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
[5] Management & Dev Hlth, Dar Es Salaam, Tanzania
[6] Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA
[7] Boston Childrens Hosp, Ctr Nutr, Div GI Nutr, Boston, MA USA
关键词
Africa; antiretroviral therapy; childhood tuberculosis; HIV/AIDS; nutrition; SOUTH-AFRICAN CHILDREN; PULMONARY TUBERCULOSIS; ANTIRETROVIRAL THERAPY; CHILDHOOD TUBERCULOSIS; EPIDEMIOLOGY; PREVALENCE; DISEASE; BURDEN; ANEMIA; IMPACT;
D O I
10.1097/QAD.0b013e32835ecb24
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
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. (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins AIDS 2013, 27:1273-1281
引用
收藏
页码:1273 / 1281
页数:9
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