W C Buck1, D Olson, M M Kabue, S Ahmed, L K Nchama, A Munthali, M C Hosseinipour, P N Kazembe. 1. Abbott Fund Children's Clinical Centre of Excellence, Baylor College of Medicine, Lilongwe, Malawi; Baylor College of Medicine International Pediatric AIDS Initiative, Houston, Texas, USA; Department of Pediatrics, Denver Health/University of Colorado, Denver, Colorado, USA.
Abstract
SETTING: A large urban pediatric human immunodeficiency virus (HIV) clinic in Lilongwe, Malawi. OBJECTIVE: To identify demographic and clinical risk factors for mortality in children co-infected with HIV and tuberculosis (TB). DESIGN: A retrospective cohort study of HIV-infected children (aged <18 years) enrolled between October 2004 and October 2010 with at least one current or historical TB diagnosis. Descriptive statistics and logistic regression analyses were performed to determine factors associated with mortality. RESULTS: A total of 1561 patients met the inclusion criteria, representing 32% of patients ever enrolled. Median age at TB diagnosis was 3.8 years (interquartile range 1.5-7.4); 60.9% had severe immune suppression and 47.6% of those with available data had some degree of acute malnutrition at TB diagnosis. Of the 1113 patients with known outcomes, 225 (20.2%) died. Children with TB-HIV co-infection not initiated on antiretroviral therapy (ART) at any time were 8.8 times more likely to die compared to those initiated on ART 0-2 months after initiation of anti-tuberculosis treatment (adjusted OR 8.83, 95%CI 4.42-17.63). Severe immunosuppression and World Health Organization Stage IV were also associated with mortality. CONCLUSIONS: Pediatric TB-HIV co-infection is common and mortality is high in this cohort of Malawian children. Prompt initiation of ART should be emphasized in this high-risk patient population.
SETTING: A large urban pediatric human immunodeficiency virus (HIV) clinic in Lilongwe, Malawi. OBJECTIVE: To identify demographic and clinical risk factors for mortality in children co-infected with HIV and tuberculosis (TB). DESIGN: A retrospective cohort study of HIV-infectedchildren (aged <18 years) enrolled between October 2004 and October 2010 with at least one current or historical TB diagnosis. Descriptive statistics and logistic regression analyses were performed to determine factors associated with mortality. RESULTS: A total of 1561 patients met the inclusion criteria, representing 32% of patients ever enrolled. Median age at TB diagnosis was 3.8 years (interquartile range 1.5-7.4); 60.9% had severe immune suppression and 47.6% of those with available data had some degree of acute malnutrition at TB diagnosis. Of the 1113 patients with known outcomes, 225 (20.2%) died. Children with TB-HIV co-infection not initiated on antiretroviral therapy (ART) at any time were 8.8 times more likely to die compared to those initiated on ART 0-2 months after initiation of anti-tuberculosis treatment (adjusted OR 8.83, 95%CI 4.42-17.63). Severe immunosuppression and World Health Organization Stage IV were also associated with mortality. CONCLUSIONS: Pediatric TB-HIV co-infection is common and mortality is high in this cohort of Malawian children. Prompt initiation of ART should be emphasized in this high-risk patient population.
Authors: C Feldacker; H Tweya; O Keiser; R Weigel; M Kalulu; L Fenner; M Egger; E Manda; J B Mwafilaso; C Kamba; S Phiri Journal: Trop Med Int Health Date: 2012-07-19 Impact factor: 2.622
Authors: Mark M Kabue; W Chris Buck; Sebastian R Wanless; Carrie M Cox; Eric D McCollum; A Chantal Caviness; Saeed Ahmed; Maria H Kim; Lineo Thahane; Andrew Devlin; Duncan Kochelani; Peter N Kazembe; Nancy R Calles; Michael B Mizwa; Gordon E Schutze; Mark W Kline Journal: Pediatrics Date: 2012-08-13 Impact factor: 7.124
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: Avy Violari; Mark F Cotton; Diana M Gibb; Abdel G Babiker; Jan Steyn; Shabir A Madhi; Patrick Jean-Philippe; James A McIntyre Journal: N Engl J Med Date: 2008-11-20 Impact factor: 91.245
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: R J Flick; M H Kim; K Simon; A Munthali; M C Hosseinipour; N E Rosenberg; P N Kazembe; J Mpunga; S Ahmed Journal: Int J Tuberc Lung Dis Date: 2016-08 Impact factor: 2.373
Authors: Augustine O Ebonyi; Stephen Oguche; Emeka U Ejeliogu; Oche O Agbaji; Nathan Y Shehu; Isaac O Abah; Atiene S Sagay; Placid O Ugoagwu; Prosper I Okonkwo; John A Idoko; Phyllis J Kanki Journal: Germs Date: 2016-03-01
Authors: Augustine O Ebonyi; Stephen Oguche; Oche O Agbaji; Atiene S Sagay; Prosper I Okonkwo; John A Idoko; Phyllis J Kanki Journal: Germs Date: 2016-12-02
Authors: Lisa V Adams; Thomas McQuillan; Helga E Naburi; Goodluck Lyatuu; Matthew M Ippolito; Andrew Saunders; Anna Kiravu; Paul Palumbo; C Fordham von Reyn Journal: Pediatr Infect Dis J Date: 2014-12 Impact factor: 2.129
Authors: Stephen M Graham; Luis E Cuevas; Patrick Jean-Philippe; Renee Browning; Martina Casenghi; Anne K Detjen; Devasena Gnanashanmugam; Anneke C Hesseling; Beate Kampmann; Anna Mandalakas; Ben J Marais; Marco Schito; Hans M L Spiegel; Jeffrey R Starke; Carol Worrell; Heather J Zar Journal: Clin Infect Dis Date: 2015-10-15 Impact factor: 9.079