Tuberculosis Treatment Outcomes Among HIV/TB-Coinfected Children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network

INTRODUCTION: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 ther...

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Veröffentlicht in:Journal of acquired immune deficiency syndromes (1999) 2017-06, Vol.75 (2), p.156-163
Hauptverfasser: Carlucci, James G, Blevins Peratikos, Meridith, Kipp, Aaron M, Lindegren, Mary L, Du, Quy T, Renner, Lorna, Reubenson, Gary, Ssali, John, Yotebieng, Marcel, Mandalakas, Anna M, Davies, Mary-Ann, Ballif, Marie, Fenner, Lukas, Pettit, April C
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container_issue 2
container_start_page 156
container_title Journal of acquired immune deficiency syndromes (1999)
container_volume 75
creator Carlucci, James G
Blevins Peratikos, Meridith
Kipp, Aaron M
Lindegren, Mary L
Du, Quy T
Renner, Lorna
Reubenson, Gary
Ssali, John
Yotebieng, Marcel
Mandalakas, Anna M
Davies, Mary-Ann
Ballif, Marie
Fenner, Lukas
Pettit, April C
description INTRODUCTION: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. METHODS: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. RESULTS: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 interval0.86 to 3.65) nor IP regimen (odds ratio 0.88; 95% confidence interval0.43 to 1.80) was associated with TB outcome. DISCUSSION: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.
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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. METHODS: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. RESULTS: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 interval0.86 to 3.65) nor IP regimen (odds ratio 0.88; 95% confidence interval0.43 to 1.80) was associated with TB outcome. DISCUSSION: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.</description><identifier>ISSN: 1525-4135</identifier><identifier>EISSN: 1944-7884</identifier><identifier>DOI: 10.1097/QAI.0000000000001335</identifier><identifier>PMID: 28234689</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Acquired immune deficiency syndrome ; Africa South of the Sahara - epidemiology ; AIDS ; AIDS/HIV ; Anti-HIV Agents - therapeutic use ; Antiretroviral drugs ; Antiretroviral therapy ; Antitubercular Agents - therapeutic use ; Asia, Southeastern - epidemiology ; CD4 Lymphocyte Count ; Child ; Child, Preschool ; Children ; Children &amp; youth ; Coinfection - drug therapy ; Coinfection - epidemiology ; Concurrent infection ; Confidence intervals ; Databases, Factual ; Diagnosis ; Diagnostic systems ; Epidemiology ; Ethambutol ; Female ; Health care ; HIV ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; Human immunodeficiency virus ; Humans ; Incidence ; Infant ; Male ; Medical diagnosis ; Nucleic acids ; Proportional Hazards Models ; Public health ; Regression analysis ; Retrospective Studies ; Treatment Outcome ; Tuberculosis ; Tuberculosis - drug therapy ; Tuberculosis - epidemiology ; Viral Load ; World Health Organization</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2017-06, Vol.75 (2), p.156-163</ispartof><rights>Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright Lippincott Williams &amp; Wilkins Jun 1, 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4305-1f87abf2dffae4587b3a41d4d8f1cdae61ca5c8c52c7964f94300fdaa9a75bce3</citedby><cites>FETCH-LOGICAL-c4305-1f87abf2dffae4587b3a41d4d8f1cdae61ca5c8c52c7964f94300fdaa9a75bce3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28234689$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carlucci, James G</creatorcontrib><creatorcontrib>Blevins Peratikos, Meridith</creatorcontrib><creatorcontrib>Kipp, Aaron M</creatorcontrib><creatorcontrib>Lindegren, Mary L</creatorcontrib><creatorcontrib>Du, Quy T</creatorcontrib><creatorcontrib>Renner, Lorna</creatorcontrib><creatorcontrib>Reubenson, Gary</creatorcontrib><creatorcontrib>Ssali, John</creatorcontrib><creatorcontrib>Yotebieng, Marcel</creatorcontrib><creatorcontrib>Mandalakas, Anna M</creatorcontrib><creatorcontrib>Davies, Mary-Ann</creatorcontrib><creatorcontrib>Ballif, Marie</creatorcontrib><creatorcontrib>Fenner, Lukas</creatorcontrib><creatorcontrib>Pettit, April C</creatorcontrib><creatorcontrib>International Epidemiology Databases to Evaluate AIDS (IeDEA) Network</creatorcontrib><creatorcontrib>for the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network</creatorcontrib><title>Tuberculosis Treatment Outcomes Among HIV/TB-Coinfected Children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>INTRODUCTION: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. METHODS: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. RESULTS: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 interval0.86 to 3.65) nor IP regimen (odds ratio 0.88; 95% confidence interval0.43 to 1.80) was associated with TB outcome. DISCUSSION: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.</description><subject>Acquired immune deficiency syndrome</subject><subject>Africa South of the Sahara - epidemiology</subject><subject>AIDS</subject><subject>AIDS/HIV</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>Asia, Southeastern - epidemiology</subject><subject>CD4 Lymphocyte Count</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Children &amp; youth</subject><subject>Coinfection - drug therapy</subject><subject>Coinfection - epidemiology</subject><subject>Concurrent infection</subject><subject>Confidence intervals</subject><subject>Databases, Factual</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>Epidemiology</subject><subject>Ethambutol</subject><subject>Female</subject><subject>Health care</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Nucleic acids</subject><subject>Proportional Hazards Models</subject><subject>Public health</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><subject>Tuberculosis</subject><subject>Tuberculosis - drug therapy</subject><subject>Tuberculosis - epidemiology</subject><subject>Viral Load</subject><subject>World Health Organization</subject><issn>1525-4135</issn><issn>1944-7884</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctu1DAUhi0Eohd4A4QssSmLtHFiT5xlmBlopIoKMbCNTpzjTlonHnxh1IfoO2M0BaEu8OZ48f2fdM5PyBuWn7O8ri6-NO15_s9jZSmekWNWc55VUvLn6S8KkXFWiiNy4v1tYhac1y_JUSGLki9kfUweNrFHp6KxfvR04xDChHOg1zEoO6GnzWTnG3rZfr_YfMiWdpw1qoADXW5HMzic6TjTsEXazgHdDGG0Mxi63o0DTqM19uaeriBADz7JgqXrn2AiBKRNu_pKz1pcrZv39DOGvXV3r8gLDcbj68d5Sr59XG-Wl9nV9ad22Vxlipe5yJiWFfS6GLQG5EJWfQmcDXyQmqkBcMEUCCWVKFRVL7iuUyrXA0ANlegVlqfk7ODdOfsjog_dNHqFxsCMNvqOyaoQFZcFT-i7J-itjWlRk6g653nFhSgSxQ-UctZ7h7rbuXECd9-xvPtdV5fq6p7WlWJvH-Wxn3D4G_rTTwLkAdhbk-7r70zco-u2CCZs_-_-BfRSoe8</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Carlucci, James G</creator><creator>Blevins Peratikos, Meridith</creator><creator>Kipp, Aaron M</creator><creator>Lindegren, Mary L</creator><creator>Du, Quy T</creator><creator>Renner, Lorna</creator><creator>Reubenson, Gary</creator><creator>Ssali, John</creator><creator>Yotebieng, Marcel</creator><creator>Mandalakas, Anna M</creator><creator>Davies, Mary-Ann</creator><creator>Ballif, Marie</creator><creator>Fenner, Lukas</creator><creator>Pettit, April C</creator><general>Copyright Wolters Kluwer Health, Inc. 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youth</topic><topic>Coinfection - drug therapy</topic><topic>Coinfection - epidemiology</topic><topic>Concurrent infection</topic><topic>Confidence intervals</topic><topic>Databases, Factual</topic><topic>Diagnosis</topic><topic>Diagnostic systems</topic><topic>Epidemiology</topic><topic>Ethambutol</topic><topic>Female</topic><topic>Health care</topic><topic>HIV</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infant</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Nucleic acids</topic><topic>Proportional Hazards Models</topic><topic>Public health</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><topic>Tuberculosis</topic><topic>Tuberculosis - drug therapy</topic><topic>Tuberculosis - epidemiology</topic><topic>Viral Load</topic><topic>World Health Organization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carlucci, James G</creatorcontrib><creatorcontrib>Blevins Peratikos, Meridith</creatorcontrib><creatorcontrib>Kipp, Aaron M</creatorcontrib><creatorcontrib>Lindegren, Mary L</creatorcontrib><creatorcontrib>Du, Quy T</creatorcontrib><creatorcontrib>Renner, Lorna</creatorcontrib><creatorcontrib>Reubenson, Gary</creatorcontrib><creatorcontrib>Ssali, John</creatorcontrib><creatorcontrib>Yotebieng, Marcel</creatorcontrib><creatorcontrib>Mandalakas, Anna M</creatorcontrib><creatorcontrib>Davies, Mary-Ann</creatorcontrib><creatorcontrib>Ballif, Marie</creatorcontrib><creatorcontrib>Fenner, Lukas</creatorcontrib><creatorcontrib>Pettit, April C</creatorcontrib><creatorcontrib>International Epidemiology Databases to Evaluate AIDS (IeDEA) Network</creatorcontrib><creatorcontrib>for the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; 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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. METHODS: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. RESULTS: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 interval0.86 to 3.65) nor IP regimen (odds ratio 0.88; 95% confidence interval0.43 to 1.80) was associated with TB outcome. DISCUSSION: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.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>28234689</pmid><doi>10.1097/QAI.0000000000001335</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Acquired immune deficiency syndrome
Africa South of the Sahara - epidemiology
AIDS
AIDS/HIV
Anti-HIV Agents - therapeutic use
Antiretroviral drugs
Antiretroviral therapy
Antitubercular Agents - therapeutic use
Asia, Southeastern - epidemiology
CD4 Lymphocyte Count
Child
Child, Preschool
Children
Children & youth
Coinfection - drug therapy
Coinfection - epidemiology
Concurrent infection
Confidence intervals
Databases, Factual
Diagnosis
Diagnostic systems
Epidemiology
Ethambutol
Female
Health care
HIV
HIV Infections - drug therapy
HIV Infections - epidemiology
Human immunodeficiency virus
Humans
Incidence
Infant
Male
Medical diagnosis
Nucleic acids
Proportional Hazards Models
Public health
Regression analysis
Retrospective Studies
Treatment Outcome
Tuberculosis
Tuberculosis - drug therapy
Tuberculosis - epidemiology
Viral Load
World Health Organization
title Tuberculosis Treatment Outcomes Among HIV/TB-Coinfected Children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network
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