Antiretroviral therapy (ART) cut the risk of newly diagnosed tuberculosis by 70% in a longitudinal study of 5040 HIV-positive children in Tanzania. Older age and more advanced HIV disease raised the risk of TB.
Tuberculosis remains a grave threat to HIV-positive children and adults in countries with high prevalence of both diseases. To determine TB incidence (the new-diagnosis rate) and predictors of TB diagnosis, researchers conducted this analysis of children enrolled in a longitudinal cohort when younger than 15 years old. The study endpoint was clinically diagnosed tuberculosis.
Median age of the study group stood at 5 years (interquartile range [IQR] 1 to 9). During a median follow-up of 0.8 years (IQR 0.2 to 2.5), TB was diagnosed in 376 of 5040 children to yield an incidence of 5.2 per 100 person-years (meaning about 5 of 100 children got diagnosed with TB every year).
Taking antiretroviral therapy for more than 180 days was associated with a 70% lower risk of TB diagnosis (relative risk 0.3, 95% confidence interval [CI] 0.2 to 0.4). Five factors independently predicted a higher TB risk, at the following relative risks (RR) and 95% CI:
• Older age at enrollment: RR 1.7, 95% CI 1.5 to 1.8
• Severe wasting: RR 1.8, 95% CI 1.3 to 2.5
• Severe immune suppression: RR 2.6, 95% CI 1.8 to 3.8
• Anemia: RR 1.4, 95% CI 1.0 to 1.9
• WHO stage 4 HIV disease: RR 4.5, 95% CI 2.4 to 8.5
“Antiretroviral therapy use is strongly associated with a reduced risk of tuberculosis among HIV-infected children, and should therefore be included in HIV care and treatment programs,” the researchers conclude.
They call for “trials of interventions designed to improve the nutritional and hematologic status of these children.”
Source: Nan Li, Karim P. Manji, Donna Spiegelman, Aisa Muya, Ramadhani S. Mwiru, Enju Liu, Guerino Chalamilla, Wafaie W. Fawzi, Christopher Duggan. Incident tuberculosis and risk factors among HIV-infected children in Tanzania. AIDS. 2013; 27: 1273-1281.
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Source: IAS