Just like in adult patients, ART reduces the risk that children with HIV will get or die from tuberculosis, according to data from six African countries.
HIV places patients at an increased risk for TB, which remains the leading infectious disease killer globally and the top cause of death among patients with HIV. Research has shown that ART reduces the risk for getting or dying from TB among adults, “but it’s effect on TB risk in children and adolescents living with HV has not been well defined,” Anna Mandalakas, MD, PhD, MSEpi, director of the Global Tuberculosis Program at Baylor College of Medicine, told Healio.
Mandalakas and colleagues analyzed data from January 2013 to June 2017 on children and adolescents aged younger than 19 years who were receiving care in seven treatment centers in Botswana, Lesotho, Malawi, Swaziland, Tanzania and Uganda. According to the study, for every 10% increase in those receiving ART, the prevalence of TB at the sites decreased by 2.33% (95% CI, 0.58%-4.4%).
Across all sites, 75% (95% CI, 67%-87%) of patients had favorable outcomes. The authors reported that on average, children with favorable TB outcomes had received care at clinics for nearly a year longer than children who had died. Of the total HIV-infected children with TB, 10% died (95% CI, 5%-15%).
Children with severe immunosuppression at TB diagnosis were four times more likely to die than children with advanced immune suppression (OR 4.29; 95% CI, 1.23-29.28).
“Adherence to ART suppresses the replication of HIV and averts immune suppression, which, in turn, decreases the risk of progression to TB disease if TB infection is present,” Alexander W. Kay, MD, BA, associate director of the Global Tuberculosis Program at Baylor College of Medicine, told Healio.
The incidence of TB was elevated among school-aged children, the authors wrote. Increases in age were associated with more favorable outcomes. Children aged 7 years or younger had a higher risk for death than school-aged children and adolescents.
“Among 5- to 10-year-old children free of HIV infection, the risk of TB is almost negligible,” Kay said. “In contrast, among children 5 to 10 years of age and living with HIV, the risk of developing TB disease remains significant.”
Source: Mandalakas A, et al. Emerg Infect Dis. 2020:doi.10.3201/eid2612.202245.