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

Andrew Edmonds1, Jean Lusiama, Sonia Napravnik

  • 1The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA. aedmonds@email.unc.edu

International Journal of Epidemiology
|May 19, 2009
PubMed

Insights

Antiretroviral therapy (ART) significantly reduces tuberculosis (TB) risk in HIV-infected children. This study shows ART halves the chance of developing TB in children living in TB-endemic regions.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Public Health

Background:

  • Tuberculosis (TB) remains a significant opportunistic infection in children living with HIV.
  • Understanding the impact of antiretroviral therapy (ART) on TB incidence is crucial for pediatric HIV management in high-burden settings.

Purpose of the Study:

  • To estimate the effect of ART on the incidence of new TB cases among HIV-infected children.
  • To quantify the risk reduction of TB associated with ART initiation and duration in a pediatric cohort.

Main Methods:

  • Analysis of a cohort of ART-naïve, TB-free HIV-infected children in Kinshasa, DRC.
  • Utilized a Cox proportional hazards marginal structural model to account for time-dependent confounders.
  • Follow-up data collected from December 2004 to April 2008.

Main Results:

  • A total of 364 children provided 596.0 person-years of follow-up.
  • TB incidence rate was 10.2 per 100 person-years with ART versus 20.4 per 100 person-years without ART.
  • ART was associated with a 51% reduction in TB hazard (Hazard Ratio: 0.51; 95% CI: 0.27-0.94).

Conclusions:

  • ART significantly reduces the risk of developing TB in HIV-infected children.
  • The protective effect of ART increases with duration on therapy, with substantial risk reduction observed after 12 months.
  • Findings support the critical role of ART in TB prevention strategies for children in TB-endemic areas.
Abstract

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