Malnutrition associated with unfavorable outcome and death among South African MDR-TB and HIV co-infected children

Hicks, Robert M.; Padayatchi, Nesri; Shah, Nishant K.; Wolf, Allison; Werner, Lise.; Sunkari, V B; O’Donnell, Max R

doi:10.5588/ijtld.14.0231

Cited by 58 publications

(43 citation statements)

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“…The occurrence of death in our cohort was relatively low when compared to adult patients with DR TB (36), but these findings are similar to those from a previous study of 84 children with MDR TB in South Africa that reported 11% mortality (36). This is likely, in part, related to prolonged hospitalization in facilities where providers are experienced in treating DR TB both with and without HIV infection.…”

Section: Discussionsupporting

confidence: 89%

Treatment Outcomes of Children With HIV Infection and Drug-resistant TB in Three Provinces in South Africa, 2005–2008

Hall

Morris

Moore

et al. 2017

Pediatric Infectious Disease Journal

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Objective To describe outcomes of HIV-infected pediatric patients with drug-resistant tuberculosis (DR TB). Methods Demographic, clinical, and laboratory data from pediatric patient charts treated for DR TB during 2005–2008 were collected retrospectively from five MDR TB hospitals in South Africa. Data were summarized and Pearson’s chi-squared test or Fisher’s exact test were used to assess differences in variables of interest by HIV status. A time-to-event analysis was conducted using days from start of treatment to death. Variables of interest were first assessed using the Kaplan-Meier method. Cox proportional hazard models were fit to estimate crude and adjusted hazard ratios. Results Of 423 eligible participants, 398 (95%) had culture-confirmed DR-TB and 238 (56%) were HIV-infected. A total of 54% were underweight, 42% were male and median age was 10.7 years (IQR: 5.5–15.3). Of the 423 participants, 245 (58%) were successfully treated, 69 (16%) died, treatment failed in 3 (1%), 36 (9%) were lost to follow-up, and 70 (17%) were still on treatment, transferred or had unknown outcomes. Time to death differed by HIV status (p=0.008), sex (p<0.001), year of TB diagnosis (p=0.05) and weight status (p=0.002). Over the two-year risk period, the adjusted rate of death was 2-fold higher among participants with HIV compared to HIV-negative participants (aHR=2.28; 95% CI: 1.11, 4.68). Conclusions Male, underweight, and HIV-infected children with DR TB were more likely to experience death when compared to other children with DR TB within this study population.

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Section: Discussionsupporting

confidence: 89%

Treatment Outcomes of Children With HIV Infection and Drug-resistant TB in Three Provinces in South Africa, 2005–2008

Hall

Morris

Moore

et al. 2017

Pediatric Infectious Disease Journal

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“…11,12 Malnutrition has also been associated with unfavourable treatment outcomes. 13,14 Timely initiation of antiretroviral therapy (ART) or of continuation of ART for patients already on treatment, through effective TB-HIV linkage, nutritional supplementation for patients in low weight groups and treatment adherence support has helped in reducing deaths and LTFU, ensuring a treatment success of 79%. 15 Only one in 16 patients were initiated on treatment within 14 days, and this was a risk factor for death.…”

Section: Public Health Actionmentioning

confidence: 99%

Unfavourable outcomes among patients with MDR-TB on the standard 24-month regimen in Maharashtra, India

Suryawanshi

Shewade²,

Nagaraja

et al. 2017

public health action

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“…Of 4812 abstracts screened, 30 abstracts with data on outcomes on 2578 adults and 147 children [44][45][46][47][48] between 1990 and 2014 (Table 1) were included in the final review. Characteristics of studies, populations and treatment are given in Table 1.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis

Isaakidis¹,

Casas²,

Das³

et al. 2015

int j tuberc lung dis

104

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S U M M A R Y B A C K G R O U N D :The incidence of multidrug-resistant tuberculosis (MDR-TB) is increasing in high human immunodeficiency virus (HIV) prevalence settings, with high associated mortality. Treatment outcomes in HIVco-infected adults and children are poorly documented. O B J E C T I V E : To systematically assess treatment outcomes among HIV-MDR-TB co-infected patients. M E T H O D S :We searched two databases and the proceedings of an annual international conference up to November 2014 for studies reporting on major clinical outcomes among HIV-MDR-TB-co-infected adults and children, and pooled the results using random-effects meta-analysis. R E S U LT S : Of 4812 abstracts and articles screened, 30 studies providing data on 2578 adults and 147 children were included. Overall pooled treatment success was 56.9% (95% confidence interval [CI] 46.2-67.6), 49.9% (95%CI 38.5-61.2) among adults and 83.4% (95%CI 74.7-92) among children. Mortality was 38% in adults (95%CI 28-48.1) and 11.4% (95%CI 5.8-17.1) in children. Loss to follow-up was higher among adults (16.1%, 95%CI 9-23.2) than among children (3.9%, 95%CI 0.9-6.9). Adverse events were experienced by the majority of patients; however, this was inconsistently documented.

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Malnutrition associated with unfavorable outcome and death among South African MDR-TB and HIV co-infected children

Abstract: It is possible to successfully treat pediatric MDR-TB-HIV even in resource-poor settings. Malnutrition is a marker for severe TB-HIV disease, and is a potential target for future interventions in these patients.

Cited by 58 publications

References 0 publications

Treatment Outcomes of Children With HIV Infection and Drug-resistant TB in Three Provinces in South Africa, 2005–2008

Treatment Outcomes of Children With HIV Infection and Drug-resistant TB in Three Provinces in South Africa, 2005–2008

Unfavourable outcomes among patients with MDR-TB on the standard 24-month regimen in Maharashtra, India

Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis

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