Incident tuberculosis and risk factors among HIV-infected children in Tanzania.
OBJECTIVE
To describe the burden of pediatric tuberculosis (TB) in a HIV-infected population and explore the demographic and clinical factors associated with the occurrence of pediatric TB.


METHODS
Longitudinal analysis of a cohort of HIV-infected children.


METHODS
The endpoint of the study was clinically diagnosed TB. Cox proportional hazard regression was used to explore the predictors of incident TB among HIV-infected children under age 15 years after enrollment into the HIV program.


RESULTS
The cohort comprised of 5040 children [median age: 5 years, interquartile range (IQR) 1-9 years]. During a median follow-up of 0.8 (IQR 0.1-2.5) years, 376 out of 5040 children met the case definition for TB. The overall incidence of TB was 5.2/100 person-years. In multivariate analyses, older age at enrollment [relative risk (RR) 1.7, 95%, confidence interval (CI) 1.5-1.8], severe wasting (RR 1.8, 95% CI 1.3-2.5), severe immune suppression (RR 2.6, 95% CI 1.8-3.8), anemia (RR 1.4, 95% CI 1.0-1.9) and WHO stage IV (RR 4.5, 95% CI 2.4-8.5) were all independently associated with a higher risk of TB. In addition, the use of antiretroviral drugs for more than 180 days reduced the risk of TB by 70% (RR 0.3, 95% CI 0.2-0.4).


CONCLUSIONS
Antiretroviral therapy (ART) use is strongly associated with a reduced risk of tuberculosis among HIV-infected children, and should therefore be included in HIV care and treatment programs. Trials of interventions designed to improve the nutritional and hematologic status of these children should also be performed.
Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
Nan
N
Li
Karim P
KP
Manji
Donna
D
Spiegelman
Aisa
A
Muya
Ramadhani S
RS
Mwiru
Enju
E
Liu
Guerino
G
Chalamilla
Wafaie W
WW
Fawzi
Christopher
C
Duggan
D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology*
D019380:Anti-HIV Agents; D000995:Antitubercular Agents