Tuberculosis among Children and Adolescents at HIV Treatment Centers in Sub-Saharan Africa

被引：25

作者：

Mandalakas, Anna M. ^{[1
,2
]}

Kay, Alexander W. ^{[1
,2
,3
]}

Bacha, Jason M. ^{[1
,2
,4
]}

Devezin, Tara ^{[1
,2
]}

Golin, Rachel ^{[5
]}

Simon, Katherine R. ^{[1
,6
,7
]}

Dhillon, Dilsher ^{[1
,2
]}

Dlamini, Sandile ^{[1
,3
]}

DiNardo, Andrew ^{[1
,2
]}

Matshaba, Mogo ^{[1
,8
]}

Sanders, Jill ^{[1
,9
]}

Thahane, Lineo ^{[1
,9
]}

Amuge, Pauline M. ^{[10
]}

Ahmed, Saeed ^{[1
,6
,7
]}

Sekadde, Moorine P. ^{[11
]}

Fida, Neway G. ^{[12
]}

Lukhele, Bhekumusa ^{[2
,3
]}

Chidah, Nodumo ^{[1
,8
]}

Damba, David ^{[1
,10
]}

Mhango, Joseph ^{[6
,7
]}

Chodota, Moses ^{[1
,13
]}

Matsoso, Makhorong ^{[1
,9
]}

Kayabu, Angelina ^{[1
,13
]}

Wanless, Richard S. ^{[1
,2
]}

Schutze, Gordon E. ^{[1
,2
]}

机构：

[1] Texas Childrens Hosp, Houston, TX 77030 USA

[2] Baylor Coll Med, 1102 Bates St,Ste 630, Houston, TX 77030 USA

[3] Childrens Fdn Swaziland, Baylor Coll Med, Mbabane, Switzerland

[4] Childrens Fdn Tanzania, Baylor Coll Med, Mbeya, Tanzania

[5] US Agcy Int Dev, Washington, DC 20523 USA

[6] Childrens Fdn Malawi, Baylor Coll Med, Lilongwe, Malawi

[7] Tech Support PEPFAR Programs Southern Africa Reg, Lilongwe, Malawi

[8] Botswana Baylor Childrens Clin Ctr Excellence, Gaborone, Botswana

[9] Childrens Fdn Lesotho, Baylor Coll Med, Maseru, Lesotho

[10] Childrens Fdn Uganda, Baylor Coll Med, Kampala, Uganda

[11] Natl TB & Leprosy Programme, Kampala, Uganda

[12] US Agcy Int Dev, Pretoria, South Africa

[13] Childrens Fdn Tanzania, Baylor Coll Med, Mwanza, Tanzania

来源：

EMERGING INFECTIOUS DISEASES | 2020年 / 26卷 / 12期

关键词：

HUMAN-IMMUNODEFICIENCY-VIRUS; PULMONARY TUBERCULOSIS; ANTIRETROVIRAL THERAPY; TREATMENT OUTCOMES; XPERT MTB/RIF; DIAGNOSIS; MORTALITY; RISK; MODELS; IMPACT;

D O I：

10.3201/eid2612.202245

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

HIV-infected children and adolescents are at increased risk for tuberculosis (TB). Antiretroviral therapy (ART) reduces TB risk in HIV-infected adults, but its effectiveness in HIV-infected children and adolescents is unknown. We analyzed data from 7 integrated pediatric HIV/TB centers in 6 countries in sub-Saharan Africa. We used a Bayesian mixed-effect model to assess association between ART and TB prevalence and used adaptive lasso regression to analyze risk factors for adverse TB outcomes. The study period encompassed 57,525 patient-years and 1,160 TB cases (2,017 cases/100,000 patient-years). Every 10% increase in ART uptake resulted in a 2.33% reduction in TB prevalence. Favorable TB outcomes were associated with increased time in care and early ART initiation, whereas severe immunosuppression was associated with death. These findings support integrated HIV/TB services for HIV-infected children and adults and demonstrate the association of ART uptake with decreased TB incidence in high HIV/TB settings.

引用

页码：2933 / 2943

页数：11

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