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Tuberculosis treatment outcomes among HIV/TB-coinfected children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) network

Carlucci, James G. and Blevins Peratikos, Meridith and Kipp, Aaron M. and Lindegren, Mary L. and Du, Quy T. and Renner, Lorna and Reubenson, Gary and Ssali, John and Yotebieng, Marcel and Mandalakas, Anna M. and Davies, Mary-Ann and Ballif, Marie and Fenner, Lukas and Pettit, April C. and International Epidemiology Databases to Evaluate Aids Network, . (2017) Tuberculosis treatment outcomes among HIV/TB-coinfected children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) network. Journal of Acquired Immune Deficiency Syndromes, 75 (2). pp. 156-163.

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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.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
UniBasel Contributors:Ballif, Marie and Fenner, Lukas
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Lippincott, Williams & Wilkins
ISSN:1525-4135
e-ISSN:1944-7884
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
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Last Modified:20 Jun 2018 08:44
Deposited On:19 Oct 2017 09:19

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