Characterizing Pediatric Tuberculosis with and without Human Immunodeficiency Virus Coinfection in Harare, Zimbabwe

Abstract

Pediatric tuberculosis (TB) represents a major barrier to reducing global TB mortality, especially in countries confronting dual TB and human immunodeficiency virus (HIV) epidemics. Our study aimed to characterize pediatric TB epidemiology in the high-burden setting of Harare, Zimbabwe, both to fill the current knowledge gap around the epidemiology of pediatric TB and to indicate areas for future research and interventions. We analyzed de-identified data of 1,051 pediatric TB cases (0-14 years) found among a total of 11,607 TB cases reported in Harare, Zimbabwe, during 2011-2012. We performed Pearson's χ test and multivariate logistic regression analysis to characterize pediatric TB and to assess predictors of HIV coinfection. Pediatric TB cases accounted for 9.1% of all TB cases reported during 2011-2012. Approximately 50% of pediatric TB cases were children younger than 5 years. Almost 60% of the under-5 age group were male, whereas almost 60% of the 10-14 age group were female. The overall HIV coinfection rate was 58.3%. Odds for HIV coinfection was higher for the 5-9 age group (adjusted odds ratio [AOR]: 2.77, 95% confidence interval [CI]: 1.97-3.94), the 10-14 group (AOR: 3.57, 95% CI: 2.52-5.11), retreatment cases (AOR: 6.17, 95% CI: 2.13, 26.16), and pulmonary TB cases (AOR: 2.39, 95% CI: 1.52, 3.75). In conclusion, our study generated evidence that pediatric TB, compounded by HIV coinfection, significantly impacts children in high-burden settings. The findings of our study indicate a critical need for targeted interventions.

Characteristics Indicative of Tuberculosis/HIV Coinfection in a High-Burden Setting: Lessons from 13,802 Incident Tuberculosis Cases in Harare, Zimbabwe

“…However, the characteristics of TB/HIV coinfection among adults remain largely unknown. 6 This cross-sectional study is the first study to include patients of all ages in the characterization of TB cases with and without HIV infection in Zimbabwe and supports the call for country-specific interventions. 1,2 METHODS Study population and data collection.…”

“…26 However, this was the first study to report the elevated risk for women in Harare, Zimbabwe. It was particularly intriguing that the female gender and TB/HIV coinfection association was neither found in a previous study conducted in the pediatric TB population in Harare 6 nor in an early study conducted in a different region of Zimbabwe. 27 Further research on the gender disparities of TB/HIV coinfection in Harare is needed to better understand why women are at an increased risk of coinfection compared with men, although men carry the largest burden of TB disease.…”

“…An elevated risk of TB/HIV coinfection in children aged 5 years and older was also reported by an earlier study conducted in Harare, Zimbabwe. 6 This unchanged risk raises a concern about the lack of progress in reducing TB/HIV coinfection in older children especially because older children in Harare have a high burden of undiagnosed HIV. 17,18 Age-specific public health interventions for TB/HIV prevention are necessary to limit future TB/HIV coinfection.…”

“…3,4 Previous studies have contributed fundamental knowledge to TB prevention strategies by identifying key TB characteristics for HIV-seropositive and -seronegative patients in some populations. [5][6][7][8] Such knowledge is important, as failure to receive antiretroviral therapy for HIV infection in TB patients is known to be a risk factor for poor health outcomes of TB/HIV-coinfected patients. 9 With a better understanding of how TB disease disseminates throughout the body of people living with and without HIV, clinicians are able to make timely, accurate diagnosis of the disease.…”

Bioactive peptides from food fermentation: A comprehensive review of their sources, bioactivities, applications, and future development

“…Of these deaths, cardiovascular disease, cancer, chronic respiratory disease, and diabetes were the leading causes (WHO, 2018). It was reported that these metabolic disorders are associated with the spontaneous exposure to extensive radiation (Morgan et al., 2015), excessive use of synthetic additives (Konduracka et al., 2014), unbalanced diet (Maiztegui et al., 2018; Solas et al., 2017), and augmentation in the rate of coinfection (Earley et al., 2018). Since the past decade, many efforts have been devoted to investigating functional foods due to their benefits in promoting health, preventing or delaying the onset of diseases, and enhancing well‐being and performance (Mazza et al., 2016).…”