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

James G. Carlucci, Meridith Blevins Peratikos, Aaron M. Kipp, Mary L. Lindegren, Quy T. Du, Lorna Renner, Gary Reubenson, John Ssali, Marcel Yotebieng, Anna M. Mandalakas, Mary Ann Davies, Marie Ballif, Lukas Fenner, April C. Pettit

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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 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. 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.

Original languageEnglish (US)
Pages (from-to)156-163
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume75
Issue number2
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

Fingerprint

Acquired Immunodeficiency Syndrome
Epidemiology
Tuberculosis
HIV
Databases
Therapeutics
Odds Ratio
Nucleic Acid Amplification Techniques
Confidence Intervals
Ethambutol
Secondary Prevention
Coinfection
Pharmaceutical Preparations
Cohort Studies
Retrospective Studies

Keywords

  • developing countries
  • HIV
  • pediatrics
  • treatment outcome
  • tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

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

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 75, No. 2, 01.06.2017, p. 156-163.

Research output: Contribution to journalArticle

Carlucci, JG, Blevins Peratikos, M, Kipp, AM, Lindegren, ML, Du, QT, Renner, L, Reubenson, G, Ssali, J, Yotebieng, M, Mandalakas, AM, Davies, MA, Ballif, M, Fenner, L & Pettit, AC 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, vol. 75, no. 2, pp. 156-163. https://doi.org/10.1097/QAI.0000000000001335
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. / Tuberculosis Treatment Outcomes among HIV/TB-Coinfected Children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network. In: Journal of Acquired Immune Deficiency Syndromes. 2017 ; Vol. 75, No. 2. pp. 156-163.
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abstract = "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 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. 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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T1 - Tuberculosis Treatment Outcomes among HIV/TB-Coinfected Children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network

AU - Carlucci, James G.

AU - Blevins Peratikos, Meridith

AU - Kipp, Aaron M.

AU - Lindegren, Mary L.

AU - Du, Quy T.

AU - Renner, Lorna

AU - Reubenson, Gary

AU - Ssali, John

AU - Yotebieng, Marcel

AU - Mandalakas, Anna M.

AU - Davies, Mary Ann

AU - Ballif, Marie

AU - Fenner, Lukas

AU - Pettit, April C.

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N2 - 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 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. 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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