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Impact of expanded antiretroviral use on incidence and prevalence of tuberculosis in children with HIV in Kenya
OBJECTIVE: To determine the prevalence and incidence of TB in HIV-infected children after the implementation of expanded ART guidelines.
DESIGN: A prospective cohort study including HIV-infected children aged 6 weeks to 14 years was conducted in Kenya. The primary outcome measure was clinically diagnosed TB. Study participants were screened for prevalent TB at enrollment using Kenya's national guidelines and followed at monthly intervals to detect incident TB. Predictors of TB were assessed using logistic regression and Cox proportional hazards regression.
RESULTS: Of 689 participants (median age 6.4 years), 509 (73.9%) were on ART at baseline. There were 51 cases of prevalent TB (7.4%) and 10 incident cases, with over 720.3 child-years of observation (incidence 1.4 per 100 child-years). Months on ART (adjusted hazard ratio [aHR] 0.91, P = 0.003; aOR 0.91, P< 0.001) and months in care before ART (aHR 0.87, P= 0.001; aOR 0.92, P < 0.001) were protective against incident and prevalent TB.
CONCLUSIONS: ART was protective against TB in this cohort of HIV-infected children with high levels of ART use. Optimal TB prevention strategies should emphasize early ART in children.
Keywords: HIV-1; epidemiology; pediatrics; sub-Saharan Africa; tuberculosis
Document Type: Research Article
Affiliations: 1: Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA; Family AIDS Care and Education Services, Nairobi, Kenya 2: Family AIDS Care and Education Services, Nairobi, Kenya; and Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya 3: Department of Medicine, University of California, San Francisco, San Francisco, California, USA 4: New Nyanza Provincial General Hospital, Kenya Ministry of Medical Services, Kisumu, Kenya 5: Family AIDS Care and Education Services, Nairobi, Kenya 6: Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya 7: Family AIDS Care and Education Services, Nairobi, Kenya; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
Publication date: 01 October 2013
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