title: Tuberculosis Treatment Outcomes Among HIV/TB-Coinfected Children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network.
abstract: Management of tuberculosis (TB) is challenging in HIV/TB-coinfected children. The World Health Organization recommends nucleic acid amplification tests for TB diagnosis, a 4-drug regimen including ethambutol during intensive phase (IP) of treatment, and initiation of antiretroviral therapy (ART) within 8 weeks of TB diagnosis. We investigated TB treatment outcomes by diagnostic modality, IP regimen, and ART status.
  
  
  
  We conducted a retrospective cohort study among HIV/TB-coinfected children enrolled at the International Epidemiology Databases to Evaluate AIDS treatment sites from 2012 to 2014. We modeled TB outcome using multivariable logistic regression including diagnostic modality, IP regimen, and ART status.
  
  
  
  Among the 386 HIV-infected children diagnosed with TB, 20% had microbiologic confirmation of TB, and 20% had unfavorable TB outcomes. During IP, 78% were treated with a 4-drug regimen. Thirty-one percent were receiving ART at the time of TB diagnosis, and 32% were started on ART within 8 weeks of TB diagnosis. Incidence of ART initiation within 8 weeks of TB diagnosis was higher for those with favorable TB outcomes (64%) compared with those with unfavorable outcomes (40%) (P = 0.04). Neither diagnostic modality (odds ratio 1.77; 95% confidence interval: 0.86 to 3.65) nor IP regimen (odds ratio 0.88; 95% confidence interval: 0.43 to 1.80) was associated with TB outcome.
  
  
  
  In this multinational study of HIV/TB-coinfected children, many were not managed as per World Health Organization guidelines. Children with favorable TB outcomes initiated ART sooner than children with unfavorable outcomes. These findings highlight the importance of early ART for children with HIV/TB coinfection, and reinforce the need for implementation research to improve pediatric TB management.
authors.affiliation: *Vanderbilt Institute for Global Health, Nashville, TN; †Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; ‡Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN; §Vanderbilt Tuberculosis Center, Nashville, TN; ‖Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; ¶Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; #Children's Hospital 1, Ho Chi Minh City, Vietnam; **University of Ghana School of Medicine and Dentistry, Accra, Ghana; ††Department of Pediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‡‡Masaka Regional Referral Hospital, Masaka, Uganda; §§The Ohio State University, College of Public Health, Columbus, OH; ‖‖Department of Pediatrics, Baylor College of Medicine, Houston, TX; ¶¶Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; ##Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; ***Swiss Tropical and Public Health Institute, Basel, Switzerland; †††University of Basel, Basel, Switzerland; and ‡‡‡Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: James G
authors.initials: JG
authors.lastname: Carlucci
authors.forename: Meridith
authors.initials: M
authors.lastname: Blevins Peratikos
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Kipp
authors.forename: Mary L
authors.initials: ML
authors.lastname: Lindegren
authors.forename: Quy T
authors.initials: QT
authors.lastname: Du
authors.forename: Lorna
authors.initials: L
authors.lastname: Renner
authors.forename: Gary
authors.initials: G
authors.lastname: Reubenson
authors.forename: John
authors.initials: J
authors.lastname: Ssali
authors.forename: Marcel
authors.initials: M
authors.lastname: Yotebieng
authors.forename: Anna M
authors.initials: AM
authors.lastname: Mandalakas
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Marie
authors.initials: M
authors.lastname: Ballif
authors.forename: Lukas
authors.initials: L
authors.lastname: Fenner
authors.forename: April C
authors.initials: AC
authors.lastname: Pettit
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001210:Asia, Southeastern / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000188:drug therapy* / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D019562:Viral Load; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents