Incidence of tuberculosis and associated mortality in a cohort of human immunodeficiency virus-infected children initiating antiretroviral therapy

© The Author 2017. Background. We assessed the incidence of tuberculosis, risk factors for tuberculosis, and the contribution of tuberculosis on mortality in a large cohort of human immunodeficiency virus (HIV)-infected children < 15 years of age initiating first-line antiretroviral therapy (ART...

Full description

Saved in:
Bibliographic Details
Main Authors: Nicolas Salvadori, Nicole Ngo-Giang-Huong, Chloé Duclercq, Suparat Kanjanavanit, Chaiwat Ngampiyaskul, Pornchai Techakunakorn, Achara Puangsombat, Julie Figoni, Jean Yves Mary, Intira J. Collins, Tim R. Cressey, Sophie Le Coeur, Wasna Sirirungsi, Marc Lallemant, Kenneth McIntosh, Gonzague Jourdain
Format: Journal
Published: 2018
Online Access:https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85021057321&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/47163
Tags: Add Tag
No Tags, Be the first to tag this record!
Institution: Chiang Mai University
id th-cmuir.6653943832-47163
record_format dspace
spelling th-cmuir.6653943832-471632018-04-25T07:24:15Z Incidence of tuberculosis and associated mortality in a cohort of human immunodeficiency virus-infected children initiating antiretroviral therapy Nicolas Salvadori Nicole Ngo-Giang-Huong Chloé Duclercq Suparat Kanjanavanit Chaiwat Ngampiyaskul Pornchai Techakunakorn Achara Puangsombat Julie Figoni Jean Yves Mary Intira J. Collins Tim R. Cressey Sophie Le Coeur Wasna Sirirungsi Marc Lallemant Kenneth McIntosh Gonzague Jourdain © The Author 2017. Background. We assessed the incidence of tuberculosis, risk factors for tuberculosis, and the contribution of tuberculosis on mortality in a large cohort of human immunodeficiency virus (HIV)-infected children < 15 years of age initiating first-line antiretroviral therapy (ART) between 1999 and 2012 in Thailand, one of the 22 high tuberculosis burden countries. Methods. A physician reviewed and classified tuberculosis cases. Incidence was the number of children with incident tuberculosis, defined as a first or recurrent tuberculosis diagnosis > 30 days after ART initiation, divided by the total person-years of follow- up (PYFU). Risk factors for incident tuberculosis were identified using Fine and Gray's competing risks models, with death from other causes treated as a competing event, and risk factors for death were identified using Cox models. Results. At ART initiation, 670 children (55% female) had a median age of 6.4 years (interquartile range, 2.0-9.6), body mass index-for-age z-score -0.8 (-1.9 to 0.0), HIV ribonucleic acid viral load 5.1 log10 copies/mL (4.6-5.6), and CD4 9% (3-17). Median duration of follow-up was 7.7 years. Tuberculosis incidence was 7 per 1000 PYFU (95% confidence interval [CI], 5-11) and decreased with ART duration. Lower age-adjusted hemoglobin, hematocrit, and CD4 at ART initiation were associated with a higher risk of incident tuberculosis. Of the 30 incident tuberculosis cases, 9 died. Diagnosis of incident tuberculosis was associated with mortality (unadjusted hazard ratio = 10.2, 95% CI = 4.8-21.5, P < .001 and adjusted hazard ratio = 5.4, 95% CI = 2.5-11.7, P < .001). Conclusions. Incident tuberculosis was strongly associated with mortality. CD4 counts or hemoglobin or hematocrit levels may prompt clinicians to consider a possible tuberculosis infection. 2018-04-25T07:24:15Z 2018-04-25T07:24:15Z 2017-06-01 Journal 20487207 20487193 2-s2.0-85021057321 10.1093/jpids/piw090 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85021057321&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/47163
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
description © The Author 2017. Background. We assessed the incidence of tuberculosis, risk factors for tuberculosis, and the contribution of tuberculosis on mortality in a large cohort of human immunodeficiency virus (HIV)-infected children < 15 years of age initiating first-line antiretroviral therapy (ART) between 1999 and 2012 in Thailand, one of the 22 high tuberculosis burden countries. Methods. A physician reviewed and classified tuberculosis cases. Incidence was the number of children with incident tuberculosis, defined as a first or recurrent tuberculosis diagnosis > 30 days after ART initiation, divided by the total person-years of follow- up (PYFU). Risk factors for incident tuberculosis were identified using Fine and Gray's competing risks models, with death from other causes treated as a competing event, and risk factors for death were identified using Cox models. Results. At ART initiation, 670 children (55% female) had a median age of 6.4 years (interquartile range, 2.0-9.6), body mass index-for-age z-score -0.8 (-1.9 to 0.0), HIV ribonucleic acid viral load 5.1 log10 copies/mL (4.6-5.6), and CD4 9% (3-17). Median duration of follow-up was 7.7 years. Tuberculosis incidence was 7 per 1000 PYFU (95% confidence interval [CI], 5-11) and decreased with ART duration. Lower age-adjusted hemoglobin, hematocrit, and CD4 at ART initiation were associated with a higher risk of incident tuberculosis. Of the 30 incident tuberculosis cases, 9 died. Diagnosis of incident tuberculosis was associated with mortality (unadjusted hazard ratio = 10.2, 95% CI = 4.8-21.5, P < .001 and adjusted hazard ratio = 5.4, 95% CI = 2.5-11.7, P < .001). Conclusions. Incident tuberculosis was strongly associated with mortality. CD4 counts or hemoglobin or hematocrit levels may prompt clinicians to consider a possible tuberculosis infection.
format Journal
author Nicolas Salvadori
Nicole Ngo-Giang-Huong
Chloé Duclercq
Suparat Kanjanavanit
Chaiwat Ngampiyaskul
Pornchai Techakunakorn
Achara Puangsombat
Julie Figoni
Jean Yves Mary
Intira J. Collins
Tim R. Cressey
Sophie Le Coeur
Wasna Sirirungsi
Marc Lallemant
Kenneth McIntosh
Gonzague Jourdain
spellingShingle Nicolas Salvadori
Nicole Ngo-Giang-Huong
Chloé Duclercq
Suparat Kanjanavanit
Chaiwat Ngampiyaskul
Pornchai Techakunakorn
Achara Puangsombat
Julie Figoni
Jean Yves Mary
Intira J. Collins
Tim R. Cressey
Sophie Le Coeur
Wasna Sirirungsi
Marc Lallemant
Kenneth McIntosh
Gonzague Jourdain
Incidence of tuberculosis and associated mortality in a cohort of human immunodeficiency virus-infected children initiating antiretroviral therapy
author_facet Nicolas Salvadori
Nicole Ngo-Giang-Huong
Chloé Duclercq
Suparat Kanjanavanit
Chaiwat Ngampiyaskul
Pornchai Techakunakorn
Achara Puangsombat
Julie Figoni
Jean Yves Mary
Intira J. Collins
Tim R. Cressey
Sophie Le Coeur
Wasna Sirirungsi
Marc Lallemant
Kenneth McIntosh
Gonzague Jourdain
author_sort Nicolas Salvadori
title Incidence of tuberculosis and associated mortality in a cohort of human immunodeficiency virus-infected children initiating antiretroviral therapy
title_short Incidence of tuberculosis and associated mortality in a cohort of human immunodeficiency virus-infected children initiating antiretroviral therapy
title_full Incidence of tuberculosis and associated mortality in a cohort of human immunodeficiency virus-infected children initiating antiretroviral therapy
title_fullStr Incidence of tuberculosis and associated mortality in a cohort of human immunodeficiency virus-infected children initiating antiretroviral therapy
title_full_unstemmed Incidence of tuberculosis and associated mortality in a cohort of human immunodeficiency virus-infected children initiating antiretroviral therapy
title_sort incidence of tuberculosis and associated mortality in a cohort of human immunodeficiency virus-infected children initiating antiretroviral therapy
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85021057321&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/47163
_version_ 1681423009753071616