Time to Develop and Predictors for Incidence of Tuberculosis among Children Receiving Antiretroviral Therapy

Abstract

Infection by the human immune deficiency virus (HIV) is the strongest risk factor for latent or new infection of tuberculosis (TB) through reduction of CD4 T-lymphocytes and cellular immune function. Almost one-third of deaths among people living with HIV are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence of tuberculosis for children living with HIV. Thus, this study assessed time to develop and predictors for incidence of tuberculosis in children attending HIV/AIDS care in public hospitals: North West Ethiopia 2021. Methods. A facility-based retrospective cohort study was conducted among 421 seropositive children on antiretroviral therapy in two hospitals between January 1, 2011 and December 31, 2020. EPI-DATA version 3.2 and STATA/14 software were used for data entry and analysis, respectively. Tuberculosis-free survival time was estimated using the Kaplan-Meier survival curve. Bivariate and multivariable Cox regression model was fitted to identify predictors at a P value <0.05 within 95% CI. Results. In the final analysis, a total of 421 seropositive children were included, of whom, 64 (15.2%) developed tuberculosis at the time of follow-up. The mean (±SD) age of the children was 10.62 ± 3.32 years, with a median (IQR) time to develop TB that was 23.5 ( IQR = ± 19 ) months. This study found that the incidence of tuberculosis was 5.9 (95% CI: 4.7; 7.6) per 100 person-years (PY) risk of observation. Cases at baseline not taking cotrimoxazol preventive therapy (CPT) ( AHR = 2.5 ; 95% CI, 1.4-4.7, P < 0.021 ), being severely stunted ( AHR = 2.9 : 95% CI, 1.2-7.8, P < 0.03 ), and having low hemoglobin level ( AHR = 4.0 ; 95% CI, 2.1-8.1, P < 0.001 ) were found to be predictors of tuberculosis. Conclusion. A higher rate of tuberculosis incidence was reported in our study as compared with previous studies in Ethiopia. Cases at baseline not taking cotrimoxazol preventive therapy (CPT), being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk to developed TB incidence.

Incidence and Predictors of Pulmonary Tuberculosis among Children Who Received Antiretroviral Therapy (ART), Northwest Ethiopia: A Multicenter Historical Cohorts Study 2009–2019

“…Equivalent to this report, however, were seropositive children who missed CPT and had significantly associated with risks of developing PTB. This is consistent with a previous document in Northwest Ethiopia and Gondar hospitals [ 14 , 26 ]. Moreover, in line with research finding with Northwest Ethiopia, Zaire, and Cameroon [ 4 , 23 , 27 ], our study indicated seropositive children who did not take IPT at baseline had a risk of developing PTB.…”

“…This is particularly critical for HIV-infected infants. Data from a randomized clinical trial conducted in Zambia demonstrated the effectiveness of cotrimoxazole prophylaxis in reducing mortality and morbidity among HIV-infected children, despite high levels of bacterial resistance [ 6 , 10 , 14 ]. One of the main challenges countries must address to scale up cotrimoxazole prophylaxis is the absence of mechanisms to systematically identify and follow up HIV-exposed infants at and after birth.…”

“…Our finding also indicated that the median (±IQR) time of TB reported and the overall TB incidence (IDR) were determined as 17.8 (±11) months and 5.86 per 100 child years (95% CI: 4.58, 7.5), respectively. The human immune deficiency virus (HIV) is the strongest risk factor for endogenous reactivation of pulmonary tuberculosis (PTB) through target reduction of CD4 and T-lymphocytes, with rapid bacilli reactivation after children are already exposed to infections [ 14 ].…”

“…A facility-based historical cohort study design was employed among 721 seropositive children in two hospitals and two health centers from January 1, 2009, to December 31, 2019. All these health facilities provide health care services for an estimated 2968 total catchment populations as depicted in [ 4 , 14 ] Figure 1 .…”

“…The sample size was calculated by using the formula for survival analysis considering the following parameters, two-sided significance level ( α = 5%), Za /2 = Z value at 95% confidence interval = 1.96, power ( Z B ) = 80%, and AHR = adjusted hazard ration = 1.8 [ 14 ].…”