Treatment Outcomes of Children With HIV Infection and Drug-resistant TB in Three Provinces in South Africa, 2005-2008

• Type of Material: Article
• Authors: Eric W. Hall, Emory University; Sapna B. Morris, U.S. Centers for Disease Control and Prevention; Brittany K. Moore, U.S. Centers for Disease Control and Prevention; Linda Erasmus, National Institute for Communicable Diseases; Ronel Odendaal, South African Medical Research Council; Heather Menzies, U.S. Centers for Disease Control and Prevention; Martie van der Walt, South African Medical Research Council; Sarah E. Smith, U.S. Centers for Disease Control and Prevention
• Language: English
• Date: 2017-12-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/INF.0000000000001691
• Title of Journal or Parent Work: Pediatric Infectious Disease Journal
• ISSN: 0891-3668
• Volume: 36
• Issue: 12
• Start Page: E322
• End Page: E327
• Grant/Funding Information: This evaluation was supported with funding provided by the US Agency for International Development and the US Centers for Disease Control and Prevention (CDC), with additional support from the South Africa National Institute for Communicable Diseases of the National Health Laboratory Service and the South African Medical Research Council (Cooperative Agreement U23-CCU021809 FOA No. PS-07-006).
• Keywords: TUBERCULOSIS; tuberculosis; pediatric; drug resistance; Infectious Diseases; MDR-TB; HIV; Science & Technology; MANAGEMENT; Pediatrics; WESTERN CAPE PROVINCE; Life Sciences & Biomedicine; HUMAN-IMMUNODEFICIENCY-VIRUS; HIGH PREVALENCE; EPIDEMIOLOGY; METAANALYSIS; CHALLENGES; SURVEILLANCE; Immunology
• Research Categories: Health Sciences, Epidemiology; Sociology, Ethnic and Racial Studies; Biology, Microbiology

Abstract

OBJECTIVE: To describe outcomes of HIV-infected pediatric patients with drug-resistant tuberculosis (DR TB). METHODS: Demographic, clinical, and laboratory data from pediatric patient charts treated for DR TB during 2005–2008 were collected retrospectively from five MDR TB hospitals in South Africa. Data were summarized and Pearson’s chi-squared test or Fisher’s exact test were used to assess differences in variables of interest by HIV status. A time-to-event analysis was conducted using days from start of treatment to death. Variables of interest were first assessed using the Kaplan-Meier method. Cox proportional hazard models were fit to estimate crude and adjusted hazard ratios. RESULTS: Of 423 eligible participants, 398 (95%) had culture-confirmed DR-TB and 238 (56%) were HIV-infected. A total of 54% were underweight, 42% were male and median age was 10.7 years (IQR: 5.5–15.3). Of the 423 participants, 245 (58%) were successfully treated, 69 (16%) died, treatment failed in 3 (1%), 36 (9%) were lost to follow-up, and 70 (17%) were still on treatment, transferred or had unknown outcomes. Time to death differed by HIV status (p=0.008), sex (p<0.001), year of TB diagnosis (p=0.05) and weight status (p=0.002). Over the two-year risk period, the adjusted rate of death was 2-fold higher among participants with HIV compared to HIV-negative participants (aHR=2.28; 95% CI: 1.11, 4.68). CONCLUSIONS: Male, underweight, and HIV-infected children with DR TB were more likely to experience death when compared to other children with DR TB within this study population.