title: Tuberculosis, before and after Antiretroviral Therapy among HIV-Infected Children in Nigeria: What Are the Risk Factors?
abstract: BACKGROUND
  In Nigeria, there is a dearth of pediatric data on the risk factors associated with tuberculosis (TB), before and after antiretroviral therapy (ART).
  
  
  METHODS
  A retrospective observational cohort study, between October 2010 and December 2013, at the Federal Medical Centre, Makurdi, Nigeria. TB was noted among children less than 15 years of age at ART enrolment (prevalent TB-PrevTB), within 6 months (early incident tuberculosis-EITB) and after 6 months (late incident tuberculosis-LITB) of a 12-month follow-up on ART. Potential risk factors for PrevTB and incident TB were assessed using the multivariate logistic and Cox regression models respectively.
  
  
  RESULTS
  Among 368 HIV-1 infected children, PrevTB was diagnosed in 73 children (19.8%). Twenty-eight EITB cases were diagnosed among 278 children over 132 person-years (py) with an EITB rate of 21.2/100 py. Twelve LITB cases were seen among 224 children over 221.9 py with a LITB rate of 5.4/100 py. A significant reduction in the incidence rates of TB was found over time (75%, p˂ 0.001). Young age of children (12-35 months, aOR; 24, 95% CI; 4.1-146.6, p ˂ 0.001; 36-59 months, aOR;21, 95%CI;4.0-114.3, p ˂ 0.001); history of TB in children (aOR; 29, 95% CI; 7.3-119.4, P˂ 0.001); severe immunosuppression (aOR;38, 95% CI;12-123.2,p ˂ 0.001); oropharyngeal candidiasis (aOR;3.3, 95% CI; 1.4-8.0, p = 0.009) and sepsis (aOR; 3.2, 95% CI;1.0-9.6, p = 0.043) increased the risk of PrevTB. Urban residency was protective against EITB (aHR; 0.1, 95% CI; 0.0-0.4, p = 0.001). Virological failure (aHR; 4.7, 95% CI; 1.3-16.5, p ˂ 0.001) and sepsis (aHR; 26, 95% CI; 5.3-131.9, p ˂ 0.001) increased the risk of LITB.
  
  
  CONCLUSIONS
  In our cohort of HIV-infected children, a significant reduction in cases of incident TB was seen following a 12-month use of ART. After ART initiation, TB screening should be optimized among children of rural residency, children with sepsis, and those with poor virological response to ART.
authors.affiliation: Department of Paediatrics, Federal Medical Centre, Makurdi, Benue State, Nigeria.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Anígilájé
authors.affiliation: Department of Community Medicine, University of Ilorin, Ilorin, Kwara State, Nigeria.
authors.forename: Sunday A
authors.initials: SA
authors.lastname: Aderibigbe
authors.affiliation: Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria.
authors.forename: Adekunle O
authors.initials: AO
authors.lastname: Adeoti
authors.affiliation: Department of Paediatrics, Federal Medical Centre, Makurdi, Benue State, Nigeria.
authors.forename: Nnamdi O
authors.initials: NO
authors.lastname: Nweke
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents