A F Auld1, M Z Tuho2, K A Ekra3, J Kouakou3, R W Shiraishi1, G Adjorlolo-Johnson4, R Marlink4, T V Ellerbrock1. 1. Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA. 2. Ministry of Health, National Programme for Medical Care of Persons Living with HIV/AIDS, Abidjan, Côte d'Ivoire. 3. Division of Global HIV/AIDS, CDC, Abidjan, Côte d'Ivoire. 4. Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, California, USA.
Abstract
SETTING: In Côte d'Ivoire, more than 2000 human immunodeficiency virus (HIV) infected children aged <15 years were started on antiretroviral therapy (ART) during 2004-2008. OBJECTIVES: To estimate tuberculosis (TB) incidence and determinants among ART enrollees. DESIGN: A nationally representative retrospective cohort study among 2110 children starting ART during 2004-2008 at 29 facilities. RESULTS: At ART initiation, the median age was 5.1 years; 82% had World Health Organization Stage III/IV, median CD4% was 11%, 42% were severely undernourished (weight-for-age Z-score [WAZ] <-3), and 150 (7%) were taking anti-tuberculosis treatment. Documentation of TB screening before ART declined from 63% to 46% during 2004-2008. Children taking anti-tuberculosis treatment at ART enrollment had a lower median CD4% (9.0% vs. 11.0%, P = 0.037) and a higher prevalence of WAZ <-3 (59% vs. 40%, P < 0.001). Among children considered TB-free at ART enrollment, TB incidence was 6.28/100 child-years during days 0-90 of ART, declining to 0.56/100 child-years after 180 days. Children with one unit higher WAZ at ART enrollment had 13% lower TB incidence (adjusted HR 0.87, 95%CI 0.77-1.00, P= 0.047). CONCLUSIONS: Ensuring clinician compliance with TB screening before ART and ensuring earlier ART initiation before children suffer from advanced HIV disease and nutritional compromise might reduce TB morbidity during ART.
SETTING: In Côte d'Ivoire, more than 2000 humanimmunodeficiency virus (HIV) infectedchildren aged <15 years were started on antiretroviral therapy (ART) during 2004-2008. OBJECTIVES: To estimate tuberculosis (TB) incidence and determinants among ART enrollees. DESIGN: A nationally representative retrospective cohort study among 2110 children starting ART during 2004-2008 at 29 facilities. RESULTS: At ART initiation, the median age was 5.1 years; 82% had World Health Organization Stage III/IV, median CD4% was 11%, 42% were severely undernourished (weight-for-age Z-score [WAZ] <-3), and 150 (7%) were taking anti-tuberculosis treatment. Documentation of TB screening before ART declined from 63% to 46% during 2004-2008. Children taking anti-tuberculosis treatment at ART enrollment had a lower median CD4% (9.0% vs. 11.0%, P = 0.037) and a higher prevalence of WAZ <-3 (59% vs. 40%, P < 0.001). Among children considered TB-free at ART enrollment, TB incidence was 6.28/100 child-years during days 0-90 of ART, declining to 0.56/100 child-years after 180 days. Children with one unit higher WAZ at ART enrollment had 13% lower TB incidence (adjusted HR 0.87, 95%CI 0.77-1.00, P= 0.047). CONCLUSIONS: Ensuring clinician compliance with TB screening before ART and ensuring earlier ART initiation before children suffer from advanced HIV disease and nutritional compromise might reduce TB morbidity during ART.
Authors: Anthony D Harries; Rony Zachariah; Elizabeth L Corbett; Stephen D Lawn; Ezio T Santos-Filho; Rhehab Chimzizi; Mark Harrington; Dermot Maher; Brian G Williams; Kevin M De Cock Journal: Lancet Date: 2010-05-18 Impact factor: 79.321
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: Carolyn Bolton-Moore; Mwangelwa Mubiana-Mbewe; Ronald A Cantrell; Namwinga Chintu; Elizabeth M Stringer; Benjamin H Chi; Moses Sinkala; Chipepo Kankasa; Craig M Wilson; Catherine M Wilfert; Albert Mwango; Jens Levy; Elaine J Abrams; Marc Bulterys; Jeffrey S A Stringer Journal: JAMA Date: 2007-10-24 Impact factor: 56.272
Authors: Naseem A Ansari; Ally H Kombe; Thomas A Kenyon; Loeto Mazhani; Nancy Binkin; Jordan W Tappero; Tesfaye Gebrekristos; Samabyawo Nyirenda; Sebastian B Lucas Journal: Pediatr Infect Dis J Date: 2003-01 Impact factor: 2.129
Authors: Andrew F Auld; Francisco Mbofana; Ray W Shiraishi; Charity Alfredo; Mauro Sanchez; Tedd V Ellerbrock; Lisa J Nelson Journal: PLoS One Date: 2013-01-22 Impact factor: 3.240
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: 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