Mortality among pulmonary tuberculosis and HIV-1 co-infected Nigerian children being treated for pulmonary tuberculosis and on antiretroviral therapy: a retrospective cohort study

Abstract

Background Mortality data, including the risk factors for mortality in HIV-infected children with pulmonary TB (PTB) being treated for PTB and who are on antiretroviral therapy (ART), are scarce in Nigeria. We determined the mortality rate and risk factors for mortality among such children, at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Jos, Nigeria.Methods We performed a retrospective cohort study on 260 PTB-HIV-1 co-infected children, aged 2 months to 13 years, being treated for PTB and on ART from July 2005 to March 2013. The mortality rate and associated risk factors were determined using multivariate Cox proportional hazards modelling.Results The mortality rate for the study cohort was 1.4 per 100 child-years of follow-up. Median follow-up time was 5.2 years (IQR, 3.5-6.0 years) with total study time being 1159 child-years. The median age of those who died was lower than that of survivors, 1.9 years (IQR, 0.6-3.6 years) versus 3.8 years (IQR, 1.8-6.0 years), p=0.005). The majority of the deaths occurred in males (13, 81.2%), those <5 years of age (14, 87.4%) and those who had severe immunosuppression (11, 68.8%). Risk factors for death were age (with the risk of dying decreasing by 25% for every 1 year increase in age, adjusted hazard ratio ( Conclusion In our clinic setting, mortality among our PTB-HIV co-infected children being treated for PTB and on ART was low. However, those presenting with severe immunosuppression and who are males and very young, should be monitored more closely during follow-up in order to further reduce mortality.

Survival and predictors of mortality among children co-infected with tuberculosis and human immunodeficiency virus at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A retrospective follow-up study

“…This result is consistent with mortality rate reported in systematic review and meta-analysis [ 22 ], and in other studies conducted in high TB and TB/HIV burden countries such as South Africa [ 23 , 19 , 24 ], and Indian [ 25 ]. However, our finding is higher than a study conducted in Nigeria (1.4 per 100 Child-Year follow-ups) [ 26 ].…”

The burden of vaccine-preventable diseases among HIV-infected and HIV-exposed children in sub-Saharan Africa: a systematic review and meta-analysis

“…Twenty-nine studies on TB were pooled to give an overall CFR estimate of 17% (95% CI: 13 -20, I 2 = 95%) which translates to 17% of all TB cases dying from the disease. Subgroup analysis shows the CFR was 18% (95% CI 6 -24) 47 in the 1991-2000 period, 6% (17 -38, I 2 = 95%) 33,[35][36][37]48,49,53,54,56,59 in 2001-2010 and 13% (95% CI 9 -17, I 2 = 96%) 15,16,18,20,[23][24][25]30,34,39,44,46,47,50,55,56 in 2011 -2018. Four studies were pooled for pneumococcal infections CFRs in HIV-infected and exposed children with a resultant rate of 15% (95% CI 4 -26, I 2 = 95%).…”

Differentiation and Characterization of Mycobacterium tuberculosis Complex Causing Pulmonary Tuberculosis across North Central Nigeria

“…Clinical examination of patients with suspected pulmonary TB was performed by the attending physicians and two consecutive 3-5 ml spot and early morning sputum samples were collected from the participants in a dry, clean, transparent, leak proof, and open-mouthed container for diagnosis of MTB/RIF using GeneXpert while a separate sputum was collected alongside in case of confirmed MTBC positive. After diagnosis, positive TB participant were referred to DOTS centers for treatment as provided by the National TB Control Program guideline in collaboration with World Health Organizations [15,16]. GeneXpert Positive sputum samples were stored at 2-8ºC in the fridge and then transported in a cold box (at +4ºC) to Zankli TB Research laboratory, Bingham University, Karu, within a week of collection for cultured.…”