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Prognostic Model for Progradient Tuberculosis Course in HIV-Infected Children
1Head of the Department of Phthisiopulmonology, Irkutsk State Medical University, 1 Krasnogo Vosstaniya St., Irkutsk, 664003, Russia; Leading Researcher, Irkutsk State Medical Academy of Postgraduate Education - Branch of the Russian Medical Academy of Continuing Professional Education, 100 Yubileyny Microdistrict, Irkutsk, 664049, Russia.
Insights
This study identifies key predictors for progressive tuberculosis in HIV-infected children, developing a prognostic model to assess disease risk. The model aids in managing tuberculosis in this vulnerable population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- HIV infection significantly increases tuberculosis (TB) risk and complicates its management.
- Progressive forms of TB in children present unique challenges for diagnosis and treatment.
- Identifying prognostic factors is crucial for timely intervention in pediatric TB cases.
Purpose of the Study:
- To determine independent predictors of a progradient (progressive) course of tuberculosis in HIV-infected children.
- To develop and validate a prognostic model for predicting the progradient course of TB in this population.
Main Methods:
- A prospective observational study involving 65 HIV-infected children under 15 years old diagnosed with TB between 2000 and 2014.
- Logistic regression was employed to construct a prognostic model based on identified risk factors.
- Model performance was evaluated using maximum likelihood, concordance coefficient, and the Hosmer-Lemeshow test.
Main Results:
- Six independent predictors for progradient TB were identified: inadequate child observation in general medical networks, lack of Bacillus Calmette-Guérin (BCG) vaccination, fatal TB in the infection source, TB diagnosis in children under 3 years, poor adherence to latent TB infection therapy, and severe immunodeficiency.
- Risk stratification was established: minimal risk (0.3-0.4), high risk (0.5-1.0), and no risk (0-0.2).
- Programs for quantitative and qualitative risk assessment were developed.
Conclusions:
- The developed prognostic model utilizes essential diagnostic data, ensuring its practical utility at all stages of medical care for HIV-infected children.
- The model facilitates risk assessment and management strategies for progressive tuberculosis in HIV-infected children.
Abstract:
The aim of the study was to define independent predictors and create a prognostic model for the progradient course of tuberculosis in HIV-infected children.
Materials And Methods:
The prospective observational study of tuberculosis cases of HIV-infected children under 15 years of age has been carried out over 2000-2014 using a continuous sampling method (n=65). Two observation groups were formed: the main group comprising children with a progradient (progressive) type of tuberculosis (n=37) and the comparison group of children with a regradient (regressive) type of the disease (n=28). The logistic regression method was used to create a prognostic model. The quality of model approximation was assessed using maximum likelihood function. Indicators of model goodness of fit are the coefficient of concordance (a permissible level of frequency disagreement is less than 20%) and Hosmer-Lemeshow test.
Results:
As a result of a paired comparative analysis based on 17 medico-biological, epidemiological and social signs, 11 statistically different parameters have been distinguished. On their basis, a functional prognostic model has been created including six independent predictors: flaws in children observation in the general medical network (b=23.962), absence of Bacillus Calmette-Guérin vaccination (b=20.404), fatal course of tuberculosis in the human source of infection (b=2.762), tuberculosis identification in children under 3 years of age (b=2.620), absence or low adherence to therapy of the latent tuberculosis infection before tuberculosis detection (b=1.859), marked or severe immunodeficiency (b=1.693). The degrees of the risk factors for the progradient tuberculosis course have been established at the following probability values (decile): at 0.3-0.4 the risk is minimal; at 0.5-1.0 the risk is high; at values of 0-0.2 there is no risk of the disease. Programs for quantitative and qualitative assessment of the risk of progradient tuberculosis course in children with HIV infection have been designed to facilitate the model use.
Conclusion:
The presented prognostic model is based on the analysis of the obligatory data in the diagnostic search making its use convenient at any stage of rendering medical aid to HIV-infected children.
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