Tuberculosis Treatment Outcomes among HIV/TB Co-Infected Children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network
Feb 20 2017
INTRODUCTION: Management of tuberculosis (TB) is challenging in HIV/TB co-infected children. The World Health Organization (WHO) recommends nucleic acid amplification tests for TB diagnosis, a four-drug regimen including ethambutol during intensive phase of treatment (IP), and initiation of antiretroviral therapy (ART) within eight weeks of TB diagnosis. We investigated TB treatment outcomes by diagnostic modality, IP regimen, and ART status.
METHODS: We conducted a retrospective cohort study among HIV/TB co-infected children enrolled at International Epidemiology Databases to Evaluate AIDS treatment sites from 2012-2014. We modeled TB outcome using multivariable logistic regression including diagnostic modality, IP regimen, and ART status.
RESULTS: Among 386 HIV-infected children diagnosed with TB, 20% had microbiological confirmation of TB, and 20% had unfavorable TB outcomes. During IP, 78% were treated with a four-drug regimen. Thirty-one percent were receiving ART at the time of TB diagnosis, and 32% were started on ART within eight weeks of TB diagnosis. Incidence of ART initiation within eight weeks of TB diagnosis was higher for those with favorable TB outcomes (64%) compared to those with unfavorable outcomes (40%) (p=0.04). Neither diagnostic modality (OR 1.77; 95%CI 0.86-3.65) nor IP regimen (OR 0.88; 95%CI 0.43-1.80) were associated with TB outcome.
DISCUSSION: In this multinational study of HIV/TB co-infected children, many were not managed per WHO 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 co-infection, and reinforce the need for implementation research to improve pediatric TB management.