title: Risk factors for mortality in Malawian children with human immunodeficiency virus and tuberculosis co-infection.
abstract: METHODS
  A large urban pediatric human immunodeficiency virus (HIV) clinic in Lilongwe, Malawi.
  
  
  OBJECTIVE
  To identify demographic and clinical risk factors for mortality in children co-infected with HIV and tuberculosis (TB).
  
  
  METHODS
  A retrospective cohort study of HIV-infected children (aged <18 years) enrolled between October 2004 and October 2010 with at least one current or historical TB diagnosis. Descriptive statistics and logistic regression analyses were performed to determine factors associated with mortality.
  
  
  RESULTS
  A total of 1561 patients met the inclusion criteria, representing 32% of patients ever enrolled. Median age at TB diagnosis was 3.8 years (interquartile range 1.5-7.4); 60.9% had severe immune suppression and 47.6% of those with available data had some degree of acute malnutrition at TB diagnosis. Of the 1113 patients with known outcomes, 225 (20.2%) died. Children with TB-HIV co-infection not initiated on antiretroviral therapy (ART) at any time were 8.8 times more likely to die compared to those initiated on ART 0-2 months after initiation of anti-tuberculosis treatment (adjusted OR 8.83, 95%CI 4.42-17.63). Severe immunosuppression and World Health Organization Stage IV were also associated with mortality.
  
  
  CONCLUSIONS
  Pediatric TB-HIV co-infection is common and mortality is high in this cohort of Malawian children. Prompt initiation of ART should be emphasized in this high-risk patient population.
authors.affiliation: Abbott Fund Children's Clinical Centre of Excellence, Baylor College of Medicine, Lilongwe, Malawi; Baylor College of Medicine International Pediatric AIDS Initiative, Houston, Texas, USA; Department of Pediatrics, Denver Health/University of Colorado, Denver, Colorado, USA.
authors.forename: W C
authors.initials: WC
authors.lastname: Buck
authors.forename: D
authors.initials: D
authors.lastname: Olson
authors.forename: M M
authors.initials: MM
authors.lastname: Kabue
authors.forename: S
authors.initials: S
authors.lastname: Ahmed
authors.forename: L K
authors.initials: LK
authors.lastname: Nchama
authors.forename: A
authors.initials: A
authors.lastname: Munthali
authors.forename: M C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: P N
authors.initials: PN
authors.lastname: Kazembe
mesh_terms: D000293:Adolescent; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000401:mortality; D015999:Multivariate Analysis; D009752:Nutritional Status; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D014504:Urban Health
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents