title: Tuberculosis in human immunodeficiency virus-infected children starting antiretroviral therapy in Côte d'Ivoire.
abstract: METHODS
  In Côte d'Ivoire, more than 2000 human immunodeficiency virus (HIV) infected children aged <15 years were started on antiretroviral therapy (ART) during 2004-2008.
  
  
  OBJECTIVE
  To estimate tuberculosis (TB) incidence and determinants among ART enrollees.
  
  
  METHODS
  A nationally representative retrospective cohort study among 2110 children starting ART during 2004-2008 at 29 facilities.
  
  
  RESULTS
  At ART initiation, the median age was 5.1 years; 82% had World Health Organization Stage III/IV, median CD4% was 11%, 42% were severely undernourished (weight-for-age Z-score [WAZ] <-3), and 150 (7%) were taking anti-tuberculosis treatment. Documentation of TB screening before ART declined from 63% to 46% during 2004-2008. Children taking anti-tuberculosis treatment at ART enrollment had a lower median CD4% (9.0% vs. 11.0%, P = 0.037) and a higher prevalence of WAZ <-3 (59% vs. 40%, P < 0.001). Among children considered TB-free at ART enrollment, TB incidence was 6.28/100 child-years during days 0-90 of ART, declining to 0.56/100 child-years after 180 days. Children with one unit higher WAZ at ART enrollment had 13% lower TB incidence (adjusted HR 0.87, 95%CI 0.77-1.00, P= 0.047).
  
  
  CONCLUSIONS
  Ensuring clinician compliance with TB screening before ART and ensuring earlier ART initiation before children suffer from advanced HIV disease and nutritional compromise might reduce TB morbidity during ART.
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: A F
authors.initials: AF
authors.lastname: Auld
authors.affiliation: Ministry of Health, National Programme for Medical Care of Persons Living with HIV/AIDS, Abidjan, Côte d'Ivoire.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Tuho
authors.affiliation: Division of Global HIV/AIDS, CDC, Abidjan, Côte d'Ivoire.
authors.forename: K A
authors.initials: KA
authors.lastname: Ekra
authors.affiliation: Division of Global HIV/AIDS, CDC, Abidjan, Côte d'Ivoire.
authors.forename: J
authors.initials: J
authors.lastname: Kouakou
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Shiraishi
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, California, USA.
authors.forename: G
authors.initials: G
authors.lastname: Adjorlolo-Johnson
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, California, USA.
authors.forename: R
authors.initials: R
authors.lastname: Marlink
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: T V
authors.initials: TV
authors.lastname: Ellerbrock
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; D015362:Child Nutrition Disorders / Q000175:diagnosis / Q000453:epidemiology; D002675:Child, Preschool; D060085:Coinfection; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D009752:Nutritional Status; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents