Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Dec;38(6):1612-21.
doi: 10.1093/ije/dyp208. Epub 2009 May 15.

Anti-retroviral therapy reduces incident tuberculosis in HIV-infected children

Andrew Edmonds  1 , Jean Lusiama, Sonia Napravnik, Faustin Kitetele, Annelies Van Rie, Frieda Behets
Affiliations

Anti-retroviral therapy reduces incident tuberculosis in HIV-infected children

Andrew Edmonds et al. Int J Epidemiol. 2009 Dec.

Abstract

Background: We aimed to estimate the effect of anti-retroviral therapy (ART) on incident tuberculosis (TB) in a cohort of HIV-infected children.

Methods: We analysed data from ART-naïve, TB disease-free children enrolled between December 2004 and April 2008 into an HIV care program in Kinshasa, Democratic Republic of Congo. To estimate the effect of ART on TB incidence while accounting for time-dependent confounders affected by exposure, a Cox proportional hazards marginal structural model was used.

Results: 364 children contributed 596.0 person-years of follow-up. At baseline, the median age was 6.9 years; 163 (44.8%) were in HIV clinical stage 3 or 4. During follow-up, 242 (66.5%) children initiated ART and 81 (22.3%) developed TB. At TB diagnosis, 41 (50.6%) were receiving ART. The TB incidence rate in those receiving ART was 10.2 per 100 person-years [95% confidence interval (CI) 7.4-13.9] compared with 20.4 per 100 person-years (95% CI 14.6-27.8) in those receiving only primary HIV care. TB incidence decreased with time on ART, from 18.9 per 100 person-years in the first 6 months to 5.3 per 100 person-years after 12 months of ART. The model-estimated TB hazard ratio for ART was 0.51 (95% CI 0.27-0.94).

Conclusions: For HIV-infected children in TB-endemic areas, ART reduces the hazard of developing TB by 50%.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Directed acyclic graph representing the causal effect of time-dependent ART on incident TB, including time-dependent measured confounders and unmeasured causal risk factors for incident TB. Numeric subscripts 0 and 1 denote the enrolment visit and subsequent visits, respectively
Figure 2
Figure 2
Schematic overview of 364 HIV-infected children initiating HIV care in Kinshasa, DRC, between December 2004 and April 2008
Figure 3
Figure 3
TB incidence rates stratified by duration of ART among 364 HIV-infected children initiating HIV care in Kinshasa, DRC, between December 2004 and April 2008
See this image and copyright information in PMC

Comment in

References

    1. Williams BG, Dye C. Antiretroviral drugs for tuberculosis control in the era of HIV/AIDS. Science. 2003;301:1535–37. - PubMed
    1. World Health Organization. Recommendations of the Interim Policy on Collaborative TB/HIV activities. Wkly Epidemiol Rec. 2004;79:6–11. - PubMed
    1. Sonnenberg P, Glynn JR, Fielding K, Murray J, Godfrey-Faussett P, Shearer S. How soon after infection with HIV does the risk of tuberculosis start to increase? A retrospective cohort study in South African gold miners. J Infect Dis. 2005;191:150–8. - PubMed
    1. Yazdanpanah Y, Chene G, Losina E, et al. Incidence of primary opportunistic infections in two human immunodeficiency virus-infected French clinical cohorts. Int J Epidemiol. 2001;30:864–71. - PubMed
    1. Autran B, Carcelain G, Li TS, et al. Positive effects of combined antiretroviral therapy on CD4+ T cell homeostasis and function in advanced HIV disease. Science. 1997;277:112–16. - PubMed

Publication types

MeSH terms

Substances