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. 2010 Jun 1;24(9):1341-9.
doi: 10.1097/QAD.0b013e328339e576.

Effect on mortality and virological response of delaying antiretroviral therapy initiation in children receiving tuberculosis treatment

Marcel Yotebieng  1 , Annelies Van Rie, Harry Moultrie, Stephen R Cole, Adaora Adimora, Frieda Behets, Tammy Meyers
Affiliations

Effect on mortality and virological response of delaying antiretroviral therapy initiation in children receiving tuberculosis treatment

Marcel Yotebieng et al. AIDS. .

Abstract

Objective: To estimate the effect of delaying antiretroviral treatment (ART) for 15, 30, or 60 days after tuberculosis (TB) treatment initiation on mortality and virological suppression.

Design: Cohort of 573 ART-naive HIV-infected children initiated on TB treatment at an outpatient clinic in South Africa between April 2004 and March 2008.

Methods: Hazard ratios for mortality and viral suppression were estimated using marginal structural models and multivariate Cox models, respectively.

Results: During follow-up (median 9.64 months), 37 HIV-infected children died after a median of 62 days of TB treatment. ART was initiated in 461 children at a median of 17 days after TB treatment initiation, 415 (90%) achieved viral suppression. The hazard ratios of death for initiating ART more than 15, more than 30, or more than 60 days of TB treatment compared with initiating within 15, 30 and 60 days, respectively, were 0.82 (95% CI: 0.48, 1.41), 0.86 (95% CI: 0.46, 1.60), and 1.32 (95% CI: 0.55, 3.16). Hazard ratios for analysis restricted to severely immunosuppressed children were: 0.92 (95% CI: 0.51, 1.63), 1.08 (95% CI: 0.56, 2.08), and 2.23 (95% CI: 0.85, 5.80), respectively. Hazard ratios for viral suppression were 0.98 (95% CI: 0.76, 1.26), 0.95, (95% CI: 0.73, 1.23), 0.84 (95% CI: 0.61, 1.15), respectively and did not change with restriction to children severely immunosuppressed.

Conclusion: In this observational study, we found that delaying ART for 2 months or more in children diagnosed with TB may be associated with poorer virological response and increased mortality, particularly in children with severe immunosuppression. These findings should be confirmed in a randomized controlled trial.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier plot of survival by timing of antiretroviral therapy (within or >60 days from TB treatment initiation) for the whole sample (a) and among severely immunosuppressed (CD4 percentage (CD4%) ≥25% in children, ≤ 11 months, ≥20% for children aged 12–35 months, or ≥15% for older children) children (b).
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References

    1. UNAIDS . AIDS epidemic update. Joint United Nations Programme on HIV/AIDS (UNAIDS); Geneva, Switzerland: 2009. pp. 1–50.
    1. Chakraborty R. HIV-1 infection in children: a clinical and immunologic overview. Curr HIV Res. 2005;3:31–41. - PubMed
    1. Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. Lancet Infect Dis. 2008;8:498–510. - PMC - PubMed
    1. Mukadi YD, Wiktor SZ, Coulibaly IM, Coulibaly D, Mbengue A, Folquet AM, et al. Impact of HIV infection on the development, clinical presentation, and outcome of tuberculosis among children in Abidjan, Cote d'Ivoire. AIDS. 1997;11:1151–1158. - PubMed
    1. Marais BJ, Graham SM, Cotton MF, Beyers N. Diagnostic and management challenges for childhood tuberculosis in the era of HIV. J Infect Dis. 2007;196(Suppl 1):S76–S85. - PubMed

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