Augustine O Ebonyi1, Stephen Oguche2, Emeka U Ejeliogu3, Oche O Agbaji4, Nathan Y Shehu4, Isaac O Abah5, Atiene S Sagay6, Placid O Ugoagwu7, Prosper I Okonkwo8, John A Idoko9, Phyllis J Kanki10. 1. MBBS, MSc, Department of Pediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria. 2. BM. Bch, Department of Pediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria. 3. MBBS, Department of Pediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria. 4. MBBS, Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria. 5. BPharm, MSc, Pharmacy Department, Jos University Teaching Hospital, Jos, Nigeria. 6. BSc, MBChB, Department of Obstetrics and Gynecology, University of Jos/ Jos University Teaching Hospital, Jos, Nigeria. 7. BSc, MSc, AIDS Prevention Initiative in Nigeria (APIN), Jos University Teaching Hospital, Jos, Nigeria. 8. MBBS, AIDS Prevention Initiative in Nigeria (APIN) Ltd. Gte, Abuja, Nigeria. 9. MBBS, National Agency for the Control of AIDS (NACA), Abuja, Nigeria. 10. DVM, SD, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Abstract
INTRODUCTION: Studies on the prevalence of and risk factors for tuberculosis (TB) among newly diagnosed human immunodeficiency virus (HIV)-infected children in sub-Saharan Africa are scarce and in Nigeria there is paucity of reported data. We determined the prevalence of and risk factors for pulmonary TB (PTB) in newly diagnosed (treatment-naïve) HIV-1 infected children at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Nigeria. METHODS: We performed a retrospective analysis of 876 children, aged 2 months - 13 years, diagnosed with HIV-1 infection between July 2005 and December 2012, of which 286 were diagnosed with PTB at presentation after TB screening. The study site was the AIDS Prevention Initiative in Nigeria (APIN)-supported Pediatric HIV clinic at JUTH, Jos. A multivariate forward logistic regression modelling was used to identify risk factors for PTB-HIV co-infection. RESULTS: The prevalence of PTB-HIV co-infection was 32% (286/876). Severe immunosuppression (SI) and World Health Organization (WHO) HIV clinical stage 3/4 were identified as independent risk factors for PTB-HIV co-infection in HIV infected children. The odds of PTB-HIV co-infection was increased two-fold in HIV-infected children with WHO clinical stage 3/4 compared to those with stage 1/2 (adjusted odds ratio (AOR) 1.76 [1.31-2.37], p<0.001) and 1.5-fold in children with SI compared to those without SI (AOR 1.52 [1.12-2.06], p=0.007). CONCLUSION: In our setting, the burden of PTB was high among newly diagnosed HIV-infected children, and late WHO HIV clinical stage and severe immunosuppression were associated with PTB-HIV co-infection. Therefore there is a clear need to improve strategies for early diagnosis of both HIV and PTB to optimize clinical outcomes.
INTRODUCTION: Studies on the prevalence of and risk factors for tuberculosis (TB) among newly diagnosed human immunodeficiency virus (HIV)-infectedchildren in sub-Saharan Africa are scarce and in Nigeria there is paucity of reported data. We determined the prevalence of and risk factors for pulmonary TB (PTB) in newly diagnosed (treatment-naïve) HIV-1 infectedchildren at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Nigeria. METHODS: We performed a retrospective analysis of 876 children, aged 2 months - 13 years, diagnosed with HIV-1 infection between July 2005 and December 2012, of which 286 were diagnosed with PTB at presentation after TB screening. The study site was the AIDS Prevention Initiative in Nigeria (APIN)-supported Pediatric HIV clinic at JUTH, Jos. A multivariate forward logistic regression modelling was used to identify risk factors for PTB-HIV co-infection. RESULTS: The prevalence of PTB-HIV co-infection was 32% (286/876). Severe immunosuppression (SI) and World Health Organization (WHO) HIV clinical stage 3/4 were identified as independent risk factors for PTB-HIV co-infection in HIV infectedchildren. The odds of PTB-HIV co-infection was increased two-fold in HIV-infectedchildren with WHO clinical stage 3/4 compared to those with stage 1/2 (adjusted odds ratio (AOR) 1.76 [1.31-2.37], p<0.001) and 1.5-fold in children with SI compared to those without SI (AOR 1.52 [1.12-2.06], p=0.007). CONCLUSION: In our setting, the burden of PTB was high among newly diagnosed HIV-infectedchildren, and late WHO HIV clinical stage and severe immunosuppression were associated with PTB-HIV co-infection. Therefore there is a clear need to improve strategies for early diagnosis of both HIV and PTB to optimize clinical outcomes.
Entities:
Keywords:
HIV-1; PTB; WHO HIV clinical stage; children; co-infection; severe immunosuppression
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