Effect of highly active antiretroviral treatment on TB incidence among HIV infected children and their clinical profile, retrospective cohort study, South West Ethiopia

Abstract

Globally, 1.8 million HIV infected children live with HIV; nearly 53% of them were receiving HIV treatment. People who are infected with HIV are 18 times more likely to develop active TB. Despite antiretroviral treatment has shown marked reduction in TB incidence, TB continues to occur in Sub-Saharan countries including Ethiopia among HIV infected people. The effect of highly active antiretroviral treatment is quite successful in developed countries. However, in developing country TB/HIV co-infection remains perplexing among children on the treatment. The aim of this study was to investigate the impact of ART on the incidence of TB among Children infected with HIV in Southwest Ethiopia. A retrospective cohort study was conducted on randomly selected 800 samples from ART clinic between 2009 and 2014. We used chi-square test, and Mann–Whitney U test to compare HAART naïve and HAART cohort. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. A total of 800 children were followed for 2942.99 child-years. The children were observed for a median of 51 months with IQR 31 and for a total of 2942.99 child-years. From 506 OIs that occurred, the most common reported OIs were Pneumonia (22%) and TB (23.6%). The overall TB incidence rate was 7.917 per 100 child years (95% CI, 6.933–9.002). Whereas among HAART (7.667 per 100-years (95% CI, 6.318–9.217) and 8.1686 per 100 person-years (95% CI 6.772–9.767) for HAART naïve. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.642 (95% CI 0.442–0.931, p < 0.02). HAART reduced the hazard of TB in HIV-infected children by 36%. This is by far less than expected.

HIV-Associated Tuberculosis in Children and Adolescents: Evolving Epidemiology, Screening, Prevention and Management Strategies

“…Evidence from other African settings also demonstrated the persistent risk of HIVassociated TB despite ART (Table 1). In a cohort of CALHIV in Ethiopia, ART only reduced the hazard ratio of TB by 36% [4]. The TB incidence rate was 7.7 per 100 person years (95% CI, 6.3-9.2) in CALHIV on ART, similar to 8.2 per 100 person years (95% CI 6.8-9.8) in ART naïve CALHIV.…”

The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis

“… 8 Adults 3072 10,000 57 0.57 16. East Africa Tiruneh F, et al [ 78 ], 2020 Ethiopia Retr. 6 Children 800 2942.99 189 7.917 17.…”

“…The level of heterogeneity in all publication date categories was significantly high ( P < 0.001). In the subgroup analysis of the target population, four studies included in this systematic review and meta-analysis [ 59 , 78 , 95 , 99 ] were excluded from the subgroup analysis because their study populations did not have a distinct age group that differentiated children from adults. In children, the incidence rate of tuberculosis was 3.42 (95% CI: 1.78, 5.57) per 100 person-years, with significant heterogeneity (I 2 = 98.49%, p < 0.001), whereas in adults, the incidence rate was 3.79 (95% CI: 2.63, 5.15) per 100 person-years, with high heterogeneity (I 2 = 99.78%, p < 0.001) (Table 2 ).…”

A survival analysis of prognostic determinant factors of time-to-death of HIV/TB co-infected patients under HAART followed-up in a public hospital in Ethiopia

“…It was proven that HAART increases the survival of HIV/ TB co-infected patients and reduces their mortality [7]. Studies of Alemu et al [8] and Tiruneh et al [9] confirmed that if HIV/AIDS patients take ART, it enables them to reduce the risk of developing active TB disease. WHO also recommends that all TB patients with HIV should be started on antiretroviral therapy (ART), irrespective of their CD4+ counts [10], and this survival time of patients was often studied by using non-parametric and parametric survival models, including Kaplan-Meier, Cox PH, and AFT models.…”