Abstract
Infection by the human immune deficiency virus (HIV) is the strongest risk factor for latent or new infection of tuberculosis (TB) through 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, there is a scarcity of information regarding the incidence of tuberculosis for children living with HIV. Thus, this study assessed time to develop and predictors for incidence of tuberculosis in children attending HIV/AIDS care in public hospitals: North West Ethiopia 2021. Methods. A facility-based retrospective cohort study was conducted among 421 seropositive children on antiretroviral therapy in two hospitals between January 1, 2011 and December 31, 2020. EPI-DATA version 3.2 and STATA/14 software were used for data entry and analysis, respectively. Tuberculosis-free survival time was estimated using the Kaplan-Meier survival curve. Bivariate and multivariable Cox regression model was fitted to identify predictors at a P value <0.05 within 95% CI. Results. In the final analysis, a total of 421 seropositive children were included, of whom, 64 (15.2%) developed tuberculosis at the time of follow-up. The mean (±SD) age of the children was 10.62 ± 3.32 years, with a median (IQR) time to develop TB that was 23.5 (IQR = ±19) months. This study found that the incidence of tuberculosis was 5.9 (95% CI: 4.7; 7.6) per 100 person-years (PY) risk of observation. Cases at baseline not taking cotrimoxazol preventive therapy (CPT) (AHR = 2.5; 95% CI, 1.4-4.7, P < 0.021), being severely stunted (AHR = 2.9: 95% CI, 1.2-7.8, P < 0.03), and having low hemoglobin level (AHR = 4.0; 95% CI, 2.1-8.1, P < 0.001) were found to be predictors of tuberculosis. Conclusion. A higher rate of tuberculosis incidence was reported in our study as compared with previous studies in Ethiopia. Cases at baseline not taking cotrimoxazol preventive therapy (CPT), being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk to developed TB incidence.
Highlights
The human immune deficiency virus (HIV) is the strongest risk factor for latent or new infection of tuberculosis (TB) through reduction of CD4 T-lymphocytes and cellular immune function [1].The coinfections of TB/HIV are bidirectional, and the diseases reinforce each other, in that HIV sustains the progression of latent tuberculosis bacilli into active TB, while tuberculosis accelerates the progression of HIV disease to its advanced clinical stage [1, 2]
Tuberculosis Research and Treatment disease is higher in sub-Saharan Africa, where HIV remains a significant problem with inadequate coverage with antiretroviral drugs [6]
In 2018, there were about 251,000 deaths from TB among PLWHIV, which accounts for 33% of total deaths associated with HIV, which is much higher than the case fatality rate expected by world health organization stages (WHO), which is ≤5% [1, 7]
Summary
The human immune deficiency virus (HIV) is the strongest risk factor for latent or new infection of tuberculosis (TB) through reduction of CD4 T-lymphocytes and cellular immune function [1].The coinfections of TB/HIV are bidirectional, and the diseases reinforce each other, in that HIV sustains the progression of latent tuberculosis bacilli into active TB, while tuberculosis accelerates the progression of HIV disease to its advanced clinical stage [1, 2]. TB is responsible for one–third of TB/HIV-associated deaths for children living with HIV [4, 5]. Tuberculosis Research and Treatment disease is higher in sub-Saharan Africa, where HIV remains a significant problem with inadequate coverage with antiretroviral drugs [6]. About 36.7 million patients were living with HIV/AIDS, and 2.1 million people became newly infected in 2015. The sub-Saharan Africa countries account for the largest proportion, with 25.6 million people living with HIV [1, 3]. In 2018, there were about 251,000 deaths from TB among PLWHIV, which accounts for 33% of total deaths associated with HIV, which is much higher than the case fatality rate expected by WHO, which is ≤5% [1, 7]. Often in resource-limited settings, estimates of TB in children have been based on extrapolation from adult data [4], but children with TB differ significantly from adult TB patients in their immunological and pathophysiological responses [7]
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