Treatment Outcomes of Children With HIV Infection and Drug-resistant TB in Three Provinces in South Africa, 2005–2008

Abstract

Objective To describe outcomes of HIV-infected pediatric patients with drug-resistant tuberculosis (DR TB). Methods Demographic, clinical, and laboratory data from pediatric patient charts treated for DR TB during 2005–2008 were collected retrospectively from five MDR TB hospitals in South Africa. Data were summarized and Pearson’s chi-squared test or Fisher’s exact test were used to assess differences in variables of interest by HIV status. A time-to-event analysis was conducted using days from start of treatment to death. Variables of interest were first assessed using the Kaplan-Meier method. Cox proportional hazard models were fit to estimate crude and adjusted hazard ratios. Results Of 423 eligible participants, 398 (95%) had culture-confirmed DR-TB and 238 (56%) were HIV-infected. A total of 54% were underweight, 42% were male and median age was 10.7 years (IQR: 5.5–15.3). Of the 423 participants, 245 (58%) were successfully treated, 69 (16%) died, treatment failed in 3 (1%), 36 (9%) were lost to follow-up, and 70 (17%) were still on treatment, transferred or had unknown outcomes. Time to death differed by HIV status (p=0.008), sex (p<0.001), year of TB diagnosis (p=0.05) and weight status (p=0.002). Over the two-year risk period, the adjusted rate of death was 2-fold higher among participants with HIV compared to HIV-negative participants (aHR=2.28; 95% CI: 1.11, 4.68). Conclusions Male, underweight, and HIV-infected children with DR TB were more likely to experience death when compared to other children with DR TB within this study population.

Low enrollment and high treatment success in children with drug-resistant tuberculosis in Ethiopia: A ten years national retrospective cohort study

“…In agreement with our finding, a previous study also indicated that HIV sero-reactive significantly predicted death in children treated for DR-TB [23]. Moreover, a study by Hall et al [18] indicated that the mortality rate is twofold higher in children who were HIV sero-reactive than those who were non-reactive. The findings of these two studies are in line with our finding in which the hazard of death or treatment failure was 5.3 times greater in HIV sero-reactive children than those who were HIV non-reactive.…”

“…These review studies' findings are in agreement with our finding. In contrast, previous studies from elsewhere in the world have shown low treatment success (ranging from 36% to 58%) in children on DR-TB treatment [15,18]. This discrepancy is most likely due to differences in sample size between the studies, severity of the disease, TB/HIV coinfection burden and treatment regimens.…”

“…This discrepancy is most likely due to differences in sample size between the studies, severity of the disease, TB/HIV coinfection burden and treatment regimens. For example, unlike study reported by Hall et al [18] which was performed on a large sample size of patients (423), the sample size of the study conducted by Fairle et al [15] was only 13 children, which might underestimate the treatment success rate. In contrast, other studies even reported a higher proportion of treatment success rates than our finding [14,22].…”

“…The number of drugs and duration of treatment required for the successful treatment outcome in children infected with DR-TB is unknown because of the lack of strong evidence from different countries on statistically optimum sample size [12,13]. Recently, there is some evidence on the magnitude and status of treatment outcomes of DR-TB in children [14][15][16][17][18][19][20][21][22][23][24][25]. This evidence indicates that the current treatment increases the likelihood of treatment success and has the potential of decreasing the mortality rate [14][15][16][17][18][19][20][21][22][23][24][25].…”

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%).…”