title: Prevalence of and risk factors for pulmonary tuberculosis among newly diagnosed HIV-1 infected Nigerian children.
abstract: BACKGROUND
  Studies on the prevalence of and risk factors for tuberculosis (TB) among newly diagnosed human immunodeficiency virus (HIV)-infected children in sub-Saharan Africa are scarce and in Nigeria there is paucity of reported data. We determined the prevalence of and risk factors for pulmonary TB (PTB) in newly diagnosed (treatment-naïve) HIV-1 infected children at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Nigeria.
  
  
  METHODS
  We performed a retrospective analysis of 876 children, aged 2 months - 13 years, diagnosed with HIV-1 infection between July 2005 and December 2012, of which 286 were diagnosed with PTB at presentation after TB screening. The study site was the AIDS Prevention Initiative in Nigeria (APIN)-supported Pediatric HIV clinic at JUTH, Jos. A multivariate forward logistic regression modelling was used to identify risk factors for PTB-HIV co-infection.
  
  
  RESULTS
  The prevalence of PTB-HIV co-infection was 32% (286/876). Severe immunosuppression (SI) and World Health Organization (WHO) HIV clinical stage 3/4 were identified as independent risk factors for PTB-HIV co-infection in HIV infected children. The odds of PTB-HIV co-infection was increased two-fold in HIV-infected children with WHO clinical stage 3/4 compared to those with stage 1/2 (adjusted odds ratio (AOR) 1.76 [1.31-2.37], p<0.001) and 1.5-fold in children with SI compared to those without SI (AOR 1.52 [1.12-2.06], p=0.007).
  
  
  CONCLUSIONS
  In our setting, the burden of PTB was high among newly diagnosed HIV-infected children, and late WHO HIV clinical stage and severe immunosuppression were associated with PTB-HIV co-infection. Therefore there is a clear need to improve strategies for early diagnosis of both HIV and PTB to optimize clinical outcomes.
authors.affiliation: MBBS, MSc, Department of Pediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Augustine O
authors.initials: AO
authors.lastname: Ebonyi
authors.affiliation: BM. Bch, Department of Pediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Stephen
authors.initials: S
authors.lastname: Oguche
authors.affiliation: MBBS, Department of Pediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Emeka U
authors.initials: EU
authors.lastname: Ejeliogu
authors.affiliation: MBBS, Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Oche O
authors.initials: OO
authors.lastname: Agbaji
authors.affiliation: MBBS, Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Nathan Y
authors.initials: NY
authors.lastname: Shehu
authors.affiliation: BPharm, MSc, Pharmacy Department, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Abah
authors.affiliation: BSc, MBChB, Department of Obstetrics and Gynecology, University of Jos/ Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Atiene S
authors.initials: AS
authors.lastname: Sagay
authors.affiliation: BSc, MSc, AIDS Prevention Initiative in Nigeria (APIN), Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Placid O
authors.initials: PO
authors.lastname: Ugoagwu
authors.affiliation: MBBS, AIDS Prevention Initiative in Nigeria (APIN) Ltd. Gte, Abuja, Nigeria.
authors.forename: Prosper I
authors.initials: PI
authors.lastname: Okonkwo
authors.affiliation: MBBS, National Agency for the Control of AIDS (NACA), Abuja, Nigeria.
authors.forename: John A
authors.initials: JA
authors.lastname: Idoko
authors.affiliation: DVM, SD, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Phyllis J
authors.initials: PJ
authors.lastname: Kanki
keywords: HIV-1; PTB; WHO HIV clinical stage; children; co-infection; severe immunosuppression