Abstract
The human immune deficiency virus (HIV) is the strongest risk factor for endogenous reactivation of pulmonary tuberculosis (PTB) through target 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, information is scarce and meager regarding PTB incidence after ART initiated for seropositive children. Methods. Facility-based multicenter historical cohort was conducted among 721 seropositive children after initiating ART from January 1, 2009, to December 31, 2019. Data from the records of children were extracted using a standardized checklist. The collected data were entered using Epi-Data version 4.2 and exported to STATA (SE) R-14 version statistical soft wares for further analysis. Bivariable and multivariable Cox regression analyses were conducted to identify predictors of PTB incidence. Results. Seven hundred twenty-one (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. During the follow-up periods, 63 (15.2%) participants developed new cases of TB; majority (61/63, 96.8%) of them were PTB. The overall incidence rate and the median (±IQR) time of PTB reported were determined as 5.86 per 100 child years (95% CI: 4.58, 7.5) and 17.8 (±11) months, respectively. At baseline, children being severely stunted (AHR = 2.9 : 95% CI, 1.2–7.8, P=0.03), with Hgb ≤10 mg/dl (AHR = 4.0; 95% CI, 2.1–8.1, P=0.001), and not given isoniazid and cotrimoxazole preventive therapy (AHR = 2.4; 95% CI: 1.2; 5.1, P=0.001) (AHR = 2.5; 95% CI, 1.4–4.7, P=0.021) were significantly associated with PTB incidence. Conclusion. A high incidence rate of PTB was observed in our study as compared with the previous finding in Ethiopia. Cases at baseline not taking IPT and CPT, being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk of developing PTB.
Highlights
People living with human immune deficiency virus (HIV) (PLWHIV) who have active TB disease were prone to several adverse outcomes
Seropositive children have the risk of increased mortality, developing AIDS-defining event, and loss to follow uprate [7]. e Ethiopian Federal HIV and AIDS Prevention and Control Office estimated that the single National HIV/AIDS is among the top ten high burden counties, in which 31% of TB patients are living with HIV [9, 10]
The present study revealed that the crude incidence of TB among children living with HIV/AIDS was determined as 8.7% (6.8; 11.04). is report is higher than the finding from Debre Tabor hospital 5.0% [2], yet it is comparable with finding stated in Arba Minch (7.2%) [5] and Tanzania (8.5%) [21] hospitals. is might be due to similarity in the study setting and the association of protective effects of antiretroviral therapy (ART)
Summary
1. Introduction e human immune deficiency virus (HIV) is the strongest risk factor for latent (PTB) or new infection of tuberculosis (TB) through reduction of CD4 T-lymphocytes and cellular immune function [1]. Introduction e human immune deficiency virus (HIV) is the strongest risk factor for latent (PTB) or new infection of tuberculosis (TB) through reduction of CD4 T-lymphocytes and cellular immune function [1] Despite this fact, both (TB/HIV) coinfections are bidirectional and comrade each other, in which HIV sustains the progression of latent tuberculosis bacilli into active TB, while tuberculosis accelerates the progression of HIV disease stages [2]. Epidemiological data on the magnitude of PTB comorbidity is important to control and prevent both diseases In this regard, facility-based studies conducted in Ethiopia have indicated that HIV-associated PTB has an increasing trend from 5.0% in Northern Ethiopia [2] to 7.2% in Southwest Ethiopia [5]. Additional studies are required in different regions of Ethiopia to identify highrisk children’s cases management. erefore, this study was intended to estimate magnitude and predictors for the occurrence of pulmonary TB among children who received antiretroviral therapy in 2020
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