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Updated: May 7, 2026
An In Vitro Model for Measuring Immune Responses to Malaria in the Context of HIV Co-infection
Published on: October 6, 2015
Risk factors for mortality in Malawian children with human immunodeficiency virus and tuberculosis co-infection
1Abbott Fund Children's Clinical Centre of Excellence, Baylor College of Medicine, Lilongwe, Malawi; Baylor College of Medicine International Pediatric AIDS Initiative, Houston, Texas, USA; Department of Pediatrics, Denver Health/University of Colorado, Denver, Colorado, USA.
Insights
Mortality is high in children with co-occurring tuberculosis and HIV in Malawi. Prompt initiation of antiretroviral therapy (ART) significantly reduces the risk of death in these vulnerable pediatric patients.
Area of Science:
- Global health
- Infectious diseases
- Pediatrics
Background:
- Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection presents a significant global health challenge, particularly in pediatric populations.
- Malawi, a high-burden country, faces a substantial rate of co-infection among children attending HIV clinics.
Purpose of the Study:
- To identify demographic and clinical risk factors associated with mortality in children co-infected with HIV and TB.
- To evaluate the impact of antiretroviral therapy (ART) initiation on mortality rates in this cohort.
Main Methods:
- Retrospective cohort study of 1561 HIV-infected children (<18 years) with TB diagnosis between 2004-2010 in Lilongwe, Malawi.
- Descriptive statistics and logistic regression analyses were employed to determine mortality risk factors.
- Outcomes were analyzed based on ART initiation timing and clinical factors like immune suppression and malnutrition.
Main Results:
- A mortality rate of 20.2% was observed in the studied pediatric TB-HIV co-infected cohort.
- Children not initiated on ART were 8.8 times more likely to die compared to those starting ART within 0-2 months of TB treatment.
- Severe immunosuppression and WHO Stage IV disease were significant risk factors for mortality.
Conclusions:
- Pediatric TB-HIV co-infection is prevalent and associated with high mortality in this Malawian cohort.
- Timely initiation of ART is crucial for improving survival rates in children with TB-HIV co-infection.
- Public health strategies should prioritize prompt ART initiation for this high-risk pediatric population.
Setting:
A large urban pediatric human immunodeficiency virus (HIV) clinic in Lilongwe, Malawi.
Objective:
To identify demographic and clinical risk factors for mortality in children co-infected with HIV and tuberculosis (TB).
Design:
A retrospective cohort study of HIV-infected children (aged <18 years) enrolled between October 2004 and October 2010 with at least one current or historical TB diagnosis. Descriptive statistics and logistic regression analyses were performed to determine factors associated with mortality.
Results:
A total of 1561 patients met the inclusion criteria, representing 32% of patients ever enrolled. Median age at TB diagnosis was 3.8 years (interquartile range 1.5-7.4); 60.9% had severe immune suppression and 47.6% of those with available data had some degree of acute malnutrition at TB diagnosis. Of the 1113 patients with known outcomes, 225 (20.2%) died. Children with TB-HIV co-infection not initiated on antiretroviral therapy (ART) at any time were 8.8 times more likely to die compared to those initiated on ART 0-2 months after initiation of anti-tuberculosis treatment (adjusted OR 8.83, 95%CI 4.42-17.63). Severe immunosuppression and World Health Organization Stage IV were also associated with mortality.
Conclusions:
Pediatric TB-HIV co-infection is common and mortality is high in this cohort of Malawian children. Prompt initiation of ART should be emphasized in this high-risk patient population.
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