title: Incidence of Tuberculosis and Associated Mortality in a Cohort of Human Immunodeficiency Virus-Infected Children Initiating Antiretroviral Therapy.
abstract: We assessed the incidence of tuberculosis, risk factors for tuberculosis, and the contribution of tuberculosis on mortality in a large cohort of human immunodeficiency virus (HIV)-infected children <15 years of age initiating first-line antiretroviral therapy (ART) between 1999 and 2012 in Thailand, one of the 22 high tuberculosis burden countries.
  A physician reviewed and classified tuberculosis cases. Incidence was the number of children with incident tuberculosis, defined as a first or recurrent tuberculosis diagnosis >30 days after ART initiation, divided by the total person-years of follow-up (PYFU). Risk factors for incident tuberculosis were identified using Fine and Gray's competing risks models, with death from other causes treated as a competing event, and risk factors for death were identified using Cox models.
  At ART initiation, 670 children (55% female) had a median age of 6.4 years (interquartile range, 2.0-9.6), body mass index-for-age z-score -0.8 (-1.9 to 0.0), HIV ribonucleic acid viral load 5.1 log10 copies/mL (4.6-5.6), and CD4 9% (3-17). Median duration of follow-up was 7.7 years. Tuberculosis incidence was 7 per 1000 PYFU (95% confidence interval [CI], 5-11) and decreased with ART duration. Lower age-adjusted hemoglobin, hematocrit, and CD4 at ART initiation were associated with a higher risk of incident tuberculosis. Of the 30 incident tuberculosis cases, 9 died. Diagnosis of incident tuberculosis was associated with mortality (unadjusted hazard ratio = 10.2, 95% CI = 4.8-21.5, P < .001 and adjusted hazard ratio = 5.4, 95% CI = 2.5-11.7, P < .001).
  Incident tuberculosis was strongly associated with mortality. CD4 counts or hemoglobin or hematocrit levels may prompt clinicians to consider a possible tuberculosis infection.
authors.affiliation: Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France.|Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Salvadori
authors.affiliation: Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France.|Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.|Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ngo-Giang-Huong
authors.affiliation: Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France.|Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.
authors.forename: Chloé
authors.initials: C
authors.lastname: Duclercq
authors.affiliation: Department of Pediatrics, Nakornping Hospital, Chiang Mai, Thailand.
authors.forename: Suparat
authors.initials: S
authors.lastname: Kanjanavanit
authors.affiliation: Department of Pediatrics, Prapokklao Hospital, Chantaburi, Thailand.
authors.forename: Chaiwat
authors.initials: C
authors.lastname: Ngampiyaskul
authors.affiliation: Department of Pediatrics, Phayao Provincial Hospital, Thailand.
authors.forename: Pornchai
authors.initials: P
authors.lastname: Techakunakorn
authors.affiliation: Department of Pediatrics, Samutprakarn Hospital, Thailand.
authors.forename: Achara
authors.initials: A
authors.lastname: Puangsombat
authors.affiliation: Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France.|Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.
authors.forename: Julie
authors.initials: J
authors.lastname: Figoni
authors.affiliation: Institut National de la Santé et de la Recherche Médicale Unité 1153, Equipe Epidémiologie Clinique, Statistique pour la Recherche en Santé, Université Paris Diderot - Paris 7, Hôpital Saint-Louis, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mary
authors.affiliation: MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, United Kingdom.
authors.forename: Intira J
authors.initials: IJ
authors.lastname: Collins
authors.affiliation: Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France.|Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.|Harvard T.H. Chan School of Public Health, Boston, Massachusetts.|Department of Molecular and Clinical Pharmacology, University of Liverpool, United Kingdom.
authors.forename: Tim R
authors.initials: TR
authors.lastname: Cressey
authors.affiliation: Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France.|Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.|Institut National d'Etudes Démographiques, Mortality, Health and Epidemiology Unit, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Le Cœur
authors.affiliation: Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.
authors.forename: Wasna
authors.initials: W
authors.lastname: Sirirungsi
authors.affiliation: Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France.|Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.|Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Marc
authors.initials: M
authors.lastname: Lallemant
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Massachusetts.
authors.forename: Kenneth
authors.initials: K
authors.lastname: McIntosh
authors.affiliation: Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France.|Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.|Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Gonzague
authors.initials: G
authors.lastname: Jourdain
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000401:mortality
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; children; incidence; mortality; tuberculosis.