title: Incident tuberculosis in HIV-positive children, adolescents and adults on antiretroviral therapy in South Africa.
abstract: To evaluate the association between age and incident tuberculosis (TB) among human immunodeficiency virus (HIV) infected patients receiving antiretroviral treatment (ART) in South Africa.
  
  
  
  Prospective cohort analysis among HIV-infected patients initiating ART between April 2004 and April 2012. Generalized estimating equations (GEE) were used with modified Poisson regression clustered by treatment site as a function of sex, age, nucleoside reverse transcriptase inhibitor, CD4 count, hemoglobin levels and year of ART initiation. Cumulative incidence functions stratified by age and controlling for death as a competing risk were used to graphically display incident TB.
  
  
  
  Although non-significant, GEE models showed that patients aged <1 year had a 40% increase in risk of TB compared to those aged 30-39.9 years. Results also showed that male patients, those with low CD4, those with low hemoglobin and those who initiated ART before 2010 were at increased risk of TB.
  
  
  
  Our results show that patients aged <1 year, males, patients with low CD4 and those with low hemoglobin at ART initiation are at increased risk of incident TB in the first 24 months of ART. Given the known transmission risk factors for children living in households with a TB contact, reducing TB incidence in HIV-positive adults could substantially impact the risk of TB in young children.
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Brennan
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: R
authors.initials: R
authors.lastname: Bonawitz
authors.affiliation: Right to Care, Johannesburg, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: Schnippel
authors.affiliation: Right to Care, Johannesburg, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Berhanu
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Maskew
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Long
authors.affiliation: Witkoppen Health and Welfare Centre, Primary Care Clinic, Johannesburg, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Bassett
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa; Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: I
authors.initials: I
authors.lastname: Sanne
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Fox
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D060085:Coinfection; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007223:Infant; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D015415:Biomarkers; D006454:Hemoglobins