Prevalence, Characteristics, Management, and Outcome of Pulmonary Tuberculosis in HIV-Infected Children in the TREAT Asia Pediatric HIV Observational Database (TApHOD)

Abstract

A multicenter, retrospective, observational study was conducted to determine prevalence, characteristics, management, and outcome of pulmonary tuberculosis (PTB) in Asian HIV-infected children in the TREAT Asia Pediatric HIV Observational Database (TApHOD). Data on PTB episodes diagnosed during the period between 12 months before antiretroviral therapy (ART) initiation and December 31, 2009 were extracted. A total of 2678 HIV-infected children were included in TApHOD over a 13-year period; 457 developed PTB, giving a period prevalence of 17.1% (range 5.7-33.0% per country). There were a total of 484 PTB episodes; 27 children had 2 episodes each. There were 21 deaths (4.3%). One third of episodes (n = 175/484) occurred after ART initiation at a median of 14.1 months (interquartile range [IQR] 2.5-28.8 months). The median (IQR) CD4 + values were 9.0% (3.0-16.0%) and 183.5 (37.8-525.0) cells/mm 3 when PTB was diagnosed. Most episodes (n = 424/436, 97.3%) had abnormal radiographic findings compatible with PTB, whereas half (n = 267/484, 55.2%) presented with clinical characteristics of PTB. One third of those tested (n = 42/122, 34.4%) had bacteriological evidence of PTB. Of the 156 episodes (32.2%) that were accompanied with extrapulmonary TB, pleuritis was the most common manifestation (81.4%). After treatment completion, most episodes (n = 396/484, 81.9%) were recorded as having positive outcomes (cured, treatment completed and child well, and improvement). The prevalence of PTB among Asian HIV-infected children in our cohort was high. Children with persistent immunosuppression remain vulnerable to PTB even after ART initiation.

Childhood tuberculosis treatment outcome and its association with HIV co-infection in Ethiopia: a systematic review and meta-analysis

“…Despite a limited study regarding this topic in the country, we analyzed six studies to estimate the pooled treatment outcome of tuberculosis. In this systemic review, successful treatment outcome of childhood TB was 79.62% (95% CI 73.22, 86.02) which is in line with the study conducted in the Asia region (81.9%) [18]. However, it is lower than from the global recommendation suggested by the WHO which is ≥ 90% successful treatment outcome in the End TB strategy [1] and the study conducted from Bhutan Southeast Asia (93%) successful treatment outcome [19].…”

Tuberculosis in HIV-infected children in Europe, Thailand and Brazil: paediatric TB-HIV EuroCoord study

“…Successful anti-tuberculosis treatment (ATT) outcomes in HIV-infected children vary across settings, ranging from 69% to 88%. 2, [10][11] Concomitant ATT may compromise HIV virological control due to drug interactions between rifamycins and some antiretrovirals, leading to longer time to viral load (VL) suppression and higher resistance mutation rates. [12][13][14] Data on TB in children living with HIV in high-and middle-income settings in the combination ART era are scarce.…”

Time to develop tuberculosis and predictors of incidence among anti-retroviral therapy children on two selected hospitals at benishangule Gumuz region, North West Ethiopia: A retrospective cohort study

“…It is one of the leading lethal opportunistic infection with 30-40% lifetime incidence risk for HIV infected children [9,10]. Global systemic review and meta-analysis on incidence of tuberculosis among PLWHIV in 2013 indicated , the incidence burden has variation in continental perspective [11], which is 31.25% in African countries, 25.06% in Latin America countries, 17.21% in Asian countries, 20.11% in European countries, and 14.84% in the USA [12]. Several studies in African countries have shown that the incidence of TB among HIV positive children ranges from 1-9.9 per 100PY [9][10][11]13] with different times of immunological and pathophysiological response for tuberculosis incidence [14,15], for instance in Uganda & Zimbabwe it was 1.9/100 P-Y [11] and in Tanzania it was 5.2/100 P-Y [10].…”

“…Mainly, bedridden functional status [20] WHO stage 3 & 4, not on ,anemia [20,23], rural residence [20], under nutrition [17] poor adherence [18]. Currently, tuberculosis incidence in peadtrics and children is an emerging and global concern due to its one of leading lethal opportunistic infection for children living with HIV [24]. Although, studies have been conducted on TB incidence among children on ART near the major cities [4] , the incidence of TB among children on ART at rural and nomadic community is incompletely described and overlooked [20,25].…”

“…Currently, tuberculosis incidence in peadtrics and children is an emerging and global concern due to its one of leading lethal opportunistic infection for children living with HIV [24]. Although, studies have been conducted on TB incidence among children on ART near the major cities [4] , the incidence of TB among children on ART at rural and nomadic community is incompletely described and overlooked [20,25]. In addition, information on the time when TB develops among children on ART is lacking too [11,19].…”