SETTING: Antiretroviral therapy (ART) reduces pulmonary tuberculosis (PTB) in human immunodeficiency virus (HIV) infected children. Recent ART recommendations have increased the number of children on ART. OBJECTIVE: To determine the prevalence and incidence of TB in HIV-infected children after the implementation of expanded ART guidelines. DESIGN: A prospective cohort study including HIV-infected children aged 6 weeks to 14 years was conducted in Kenya. The primary outcome measure was clinically diagnosed TB. Study participants were screened for prevalent TB at enrollment using Kenya's national guidelines and followed at monthly intervals to detect incident TB. Predictors of TB were assessed using logistic regression and Cox proportional hazards regression. RESULTS: Of 689 participants (median age 6.4 years), 509 (73.9%) were on ART at baseline. There were 51 cases of prevalent TB (7.4%) and 10 incident cases, with over 720.3 child-years of observation (incidence 1.4 per 100 child-years). Months on ART (adjusted hazard ratio [aHR] 0.91, P = 0.003; aOR 0.91, P< 0.001) and months in care before ART (aHR 0.87, P= 0.001; aOR 0.92, P < 0.001) were protective against incident and prevalent TB. CONCLUSIONS: ART was protective against TB in this cohort of HIV-infected children with high levels of ART use. Optimal TB prevention strategies should emphasize early ART in children.
SETTING: Antiretroviral therapy (ART) reduces pulmonary tuberculosis (PTB) in humanimmunodeficiency virus (HIV) infectedchildren. Recent ART recommendations have increased the number of children on ART. OBJECTIVE: To determine the prevalence and incidence of TB in HIV-infectedchildren after the implementation of expanded ART guidelines. DESIGN: A prospective cohort study including HIV-infectedchildren aged 6 weeks to 14 years was conducted in Kenya. The primary outcome measure was clinically diagnosed TB. Study participants were screened for prevalent TB at enrollment using Kenya's national guidelines and followed at monthly intervals to detect incident TB. Predictors of TB were assessed using logistic regression and Cox proportional hazards regression. RESULTS: Of 689 participants (median age 6.4 years), 509 (73.9%) were on ART at baseline. There were 51 cases of prevalent TB (7.4%) and 10 incident cases, with over 720.3 child-years of observation (incidence 1.4 per 100 child-years). Months on ART (adjusted hazard ratio [aHR] 0.91, P = 0.003; aOR 0.91, P< 0.001) and months in care before ART (aHR 0.87, P= 0.001; aOR 0.92, P < 0.001) were protective against incident and prevalent TB. CONCLUSIONS:ART was protective against TB in this cohort of HIV-infectedchildren with high levels of ART use. Optimal TB prevention strategies should emphasize early ART in children.
Authors: Stephen M Graham; Tahmeed Ahmed; Farhana Amanullah; Renee Browning; Vicky Cardenas; Martina Casenghi; Luis E Cuevas; Marianne Gale; Robert P Gie; Malgosia Grzemska; Ed Handelsman; Mark Hatherill; Anneke C Hesseling; Patrick Jean-Philippe; Beate Kampmann; Sushil Kumar Kabra; Christian Lienhardt; Jennifer Lighter-Fisher; Shabir Madhi; Mamodikoe Makhene; Ben J Marais; David F McNeeley; Heather Menzies; Charles Mitchell; Surbhi Modi; Lynne Mofenson; Philippa Musoke; Sharon Nachman; Clydette Powell; Mona Rigaud; Vanessa Rouzier; Jeffrey R Starke; Soumya Swaminathan; Claire Wingfield Journal: J Infect Dis Date: 2012-03-22 Impact factor: 5.226
Authors: Shabir A Madhi; Sharon Nachman; Avy Violari; Soyeon Kim; Mark F Cotton; Raziya Bobat; Patrick Jean-Philippe; George McSherry; Charles Mitchell Journal: N Engl J Med Date: 2011-07-07 Impact factor: 91.245
Authors: S Bakeera-Kitaka; A Conesa-Botella; A Dhabangi; A Maganda; A Kekitiinwa; R Colebunders; D R Boulware Journal: Int J Tuberc Lung Dis Date: 2011-08 Impact factor: 2.373
Authors: Lilly M Verhagen; Adilia Warris; Dick van Soolingen; Ronald de Groot; Peter W M Hermans Journal: Pediatr Infect Dis J Date: 2010-10 Impact factor: 2.129
Authors: Heather J Zar; Mark F Cotton; Stanzi Strauss; Janine Karpakis; Gregory Hussey; H Simon Schaaf; Helena Rabie; Carl J Lombard Journal: BMJ Date: 2006-11-03
Authors: Paula Braitstein; Winstone Nyandiko; Rachel Vreeman; Kara Wools-Kaloustian; Edwin Sang; Beverly Musick; John Sidle; Constantin Yiannoutsos; Samwel Ayaya; E Jane Carter Journal: Pediatr Infect Dis J Date: 2009-07 Impact factor: 2.129
Authors: Elisabetta Walters; Mark F Cotton; Helena Rabie; H Simon Schaaf; Lourens O Walters; Ben J Marais Journal: BMC Pediatr Date: 2008-01-11 Impact factor: 2.125
Authors: L H Chaisson; F Naufal; P Delgado-Barroso; H S Alvarez-Manzo; K O Robsky; C R Miller; J E Golub; A E Shapiro Journal: Int J Tuberc Lung Dis Date: 2021-06-01 Impact factor: 3.427
Authors: Angela M Crook; Anna Turkova; Victor Musiime; Mutsa Bwakura-Dangarembizi; Sabrina Bakeera-Kitaka; Patricia Nahirya-Ntege; Margaret Thomason; Peter Mugyenyi; Philippa Musoke; Adeodata Kekitiinwa; Paula Munderi; Kusum Nathoo; Andrew J Prendergast; A Sarah Walker; Diana M Gibb Journal: BMC Med Date: 2016-03-23 Impact factor: 8.775