ART Cuts Mortality Risk in Children With HIV and Tuberculosis

Antiretroviral therapy (ART)-naïve children with human immunodeficiency virus (HIV) with suspected tuberculosis (TB) have an increased risk of mortality, according to a new study.

For their study, the researchers assessed 438 children with HIV aged 13 years or younger who had suspected TB. Follow-up lasted 6 months.
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Children initiated ART and antituberculosis treatment at the clinician’s discretion and were subsequently categorized as having confirmed TB by culture or Xpert MTB/RIF, unconfirmed TB, and unlikely TB. Kaplan-Meier methods and Cox proportional hazard models were used to evaluate mortality and related factors.

A total of 266 (41%) children were ART-naïve and were included in the present analysis. Of these children, 40 had confirmed TB, 119 had unconfirmed TB, and 107 had unlikely TB. A total of 154 (58%) children initiated antituberculosis treatment, and 212 (80%) initiated ART.

Study findings demonstrated that the 6-month mortality rate was higher in children with confirmed TB (14 deaths; 2-month survival probability 65.0%) vs children with unconfirmed TB (19 deaths; 2-month survival probability 83.5%) or unlikely TB (17 deaths; 2-month survival probability 83.5%).

Six-month mortality was also found to be lower in children with confirmed or unconfirmed TB who initiated antituberculosis treatment.

Based on multivariate analysis, factors that were found to be independently associated with mortality included ART initiation within the first month of follow-up (hazard ratio [HR] 0.08), confirmed TB (HR 6.33), young age (HR 5.90), a cluster of differentiation 4 percentage of less than 10% (HR 2.63), military features (HR 4.08), and elevated serum transaminases (HR 4.40).

“In our cohort, mortality was high in the first 6 months after suspicion of tuberculosis in ART-naive children,” the researchers concluded. “ART should be started early, particularly in children with factors associated with high mortality. Documented or empirical tuberculosis treatment decision should be accelerated to reduce mortality and allow early ART initiation.”

—Christina Vogt

Reference:

Marcy O, Tejiokem M, Msellati P, et al. Mortality and its determinants in antiretroviral treatment-naive HIV-infected children with suspected tuberculosis: an observational cohort study. Lancet HIV. 2018;5(2):e87-e95. https://doi.org/10.1016/S2352-3018(17)30206-0.