title: Malnutrition associated with unfavorable outcome and death among South African MDR-TB and HIV co-infected children.
abstract: METHODS
  Pediatric multidrug-resistant tuberculosis (MDR-TB) is complicated by difficult diagnosis, complex treatment, and high mortality. In South Africa, these challenges are amplified by human immunodeficiency virus (HIV) co-infection; however, evidence on treatment outcomes among co-infected children is limited.
  
  
  OBJECTIVE
  Using conventional and new pediatric definitions, to describe treatment outcomes and identify risk factors for unfavorable outcome and mortality in children aged <15 years with MDR-TB or extensively drug-resistant TB (XDR-TB) in KwaZulu-Natal, South Africa.
  
  
  METHODS
  Retrospective cohort study in a regional TB referral hospital.
  
  
  RESULTS
  From January 2009 to June 2010, 84 children (median age 8 years, IQR 4-12) with MDR-TB (n = 78) or XDR-TB (n = 6) initiated treatment. Sixty-four (77%) were HIV-positive and 62 (97%) received antiretroviral therapy. Sixty-six (79%) achieved favorable treatment outcomes. Overall mortality was 11% (n = 9) at 18 months after initiation of treatment. Malnutrition (aOR 27.4, 95%CI 2.7-278.7) and severe radiographic findings (aOR 4.68, 95%CI 1.01-21.9) were associated with unfavorable outcome. New pediatric outcome definitions increased the proportion classified as cured.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Hicks
authors.affiliation: Centre for AIDS Programme of Research in South Africa, Durban, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Padayatchi
authors.affiliation: Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: N S
authors.initials: NS
authors.lastname: Shah
authors.affiliation: Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: A
authors.initials: A
authors.lastname: Wolf
authors.affiliation: Centre for AIDS Programme of Research in South Africa, Durban, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Werner
authors.affiliation: King DinuZulu Hospital, Sydenham, South Africa.
authors.forename: V B
authors.initials: VB
authors.lastname: Sunkari
authors.affiliation: Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: O'Donnell
mesh_terms: D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D015362:Child Nutrition Disorders / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D060085:Coinfection; D003906:Developing Countries; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D009752:Nutritional Status; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents