Incidence and associated factors of pulmonary tuberculosis in HIV-infected children after highly active antiretroviral therapy (HAART) in China: a retrospective study

Abstract

China is a country with high tuberculosis (TB) incidence but relatively low HIV prevalence. However, due to difficulties in diagnosis and reporting, true burden of HIV-associated TB in children is unknown. The objective of this study was to describe the incidence of pulmonary TB (PTB) after antiretroviral therapy (ART) and to study risk factors. A retrospective study was performed based on routinely collected data from China national pediatric free antiretroviral treatment database. A total of 3365 children under 15 years on ART from July 2005 to October 2012 were included. Multivariable logistic regression was used to detect associated factors. Two thousand nine hundred and ninety (89%) children got infected from HIV-positive mother, with median age of 6.7 (4.1, 10.0) years at highly active antiretroviral therapy (HAART) initiation in this program. Seventy-seven (2.3%) children were diagnosed with PTB after ART during 7.3 years cohort observation. Median time of occurrence was 212 (30–514) days. Overall incidence was 0.83 (0.65–1.01)/100 person-years (py), with the peak of 3.6/100 py in the first 3 months after antiretroviral treatment. WHO stage IV at baseline showed 2 (95% CI 1.0–6.8) times more risk for developing TB. Late clinical stage at ART initiation was shown to relate with TB incidence. PTB coinfection leads to higher mortality. Early diagnosis and treatment of HIV are highly required to reduce HIV-associated morbidity and mortality due to TB.

Keywords:

• pediatric HIV
• tuberculosis
• antiretroviral therapy
• mortality
• early initiation of antiretroviral treatment

Presented as poster in the 7th IAS conference on HIV pathogenesis, treatment and prevention. Kuala Lumpur, Malaysia, 30 June to 3 July 2013.

Presented as poster in the 7th IAS conference on HIV pathogenesis, treatment and prevention. Kuala Lumpur, Malaysia, 30 June to 3 July 2013.

Acknowledgments

The authors thank for all the pediatric antiretroviral treatment center and CDC staff for program assistance. We thank for Anne Buve of Institute of Tropical Medicine, Antwerp, Belgium for her coaching and great contribution and Ray Y. Chen for all his careful comments.

Funding

Funding for this project was provided by Chinese Government, China National Pediatric Free ART Program, National Center for AIDS/STD Control and Prevention of the Chinese Center for Disease Control and Prevention; Grants from the Important National Science and Technology Specific Projects in China [grant number 2012ZX10001004].

Additional information

Funding

Funding: Funding for this project was provided by Chinese Government, China National Pediatric Free ART Program, National Center for AIDS/STD Control and Prevention of the Chinese Center for Disease Control and Prevention; Grants from the Important National Science and Technology Specific Projects in China [grant number 2012ZX10001004].