Prognostic Model for Progradient Tuberculosis Course in HIV-Infected Children

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.