HIV matters when diagnosing TB in young children: an ancillary analysis in children enrolled in the INPUT stepped
L Powell1, L Denoeud-Ndam2, N Herrera3
1Division of Pediatric Infectious Diseases, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
Insights
Children living with HIV (CLHIV) present with different TB symptoms and are diagnosed faster. Integrating TB and nutrition services is crucial for better outcomes in CLHIV.
Area of Science:
- Pediatric infectious diseases
- Global health
- HIV/TB co-infection research
Background:
- Children under five, especially those with HIV (CLHIV), face rapid tuberculosis (TB) progression.
- This study compares TB clinical presentations, diagnostics, and outcomes in CLHIV versus children without HIV in Cameroon and Kenya.
Purpose of the Study:
- To describe and compare TB clinical presentations, diagnostic pathways, and treatment outcomes in CLHIV and HIV-uninfected children.
- To investigate the association between HIV infection and the time to TB diagnosis in young children.
Main Methods:
- Sub-analysis of a cluster-randomized trial (May 2019-March 2021) including children under five with TB.
- Compared TB clinical features, diagnostic methods, and treatment outcomes between CLHIV and HIV-uninfected children.
- Used logistic regression to analyze factors associated with HIV status and time to TB diagnosis.
Main Results:
- 14.0% of 157 pediatric TB patients were co-infected with HIV (CLHIV).
- CLHIV more frequently presented with acute malnutrition and had a shorter time to TB diagnosis (associated with HIV, fatigue, household TB contact).
- Older age, night sweats, and acute malnutrition were linked to delayed TB diagnosis; case fatality rates were similar (9% in CLHIV vs. 4% in HIV-uninfected).
Conclusions:
- Advocates for better integration of TB services into pediatric care, emphasizing nutrition services.
- Highlights the importance of non-sputum-based TB diagnostics, particularly for CLHIV.
- Suggests improved diagnostic pathways are needed for timely TB detection in CLHIV.
Background:
Children under age five years, particularly those living with HIV (CLHIV), are at risk for rapid progression of tuberculosis (TB). We aimed to describe TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV compared to children without HIV in Cameroon and Kenya.
Methods:
This sub-analysis of a cluster-randomized trial evaluating the integration of pediatric TB services from May 2019 to March 2021 enrolled children age < 5 years with TB. We estimated the HIV infection rate with 95% confidence interval (CI). We compared TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV and children without HIV. Finally, we investigated whether HIV infection was associated with a shorter time to TB diagnosis (≤ 3 months from symptoms onset) after adjusting for covariates. Univariable and multivariable logistic regression analysis were performed with adjusted odds ratios (AORs) presented as measures of the association of covariates with HIV status and with shorter time to TB diagnosis.
Results:
We enrolled 157 children with TB (mean age was 1.5 years) and 22/157 (14.0% [9.0-20.4%]) were co-infected with HIV. CLHIV were more likely to initially present with acute malnutrition (AOR 3.16 [1.14-8.71], p = 0.027). Most TB diagnoses (140/157, 89%) were made clinically with pulmonary TB being the most common presentation; however, there was weak evidence of more frequent bacteriologic confirmation of TB in CLHIV, 18% vs. 9% (p = 0.067), due to the contribution of lateral-flow urine lipoarabinomannan to the diagnosis. HIV positivity (AOR: 6.10 [1.32-28.17], p = 0.021) was independently associated with a shorter time to TB diagnosis as well as fatigue (AOR: 6.58 [2.28-18.96], p = 0.0005), and existence of a household contact diagnosed with TB (AOR: 5.60 [1.58-19.83], p = 0.0075), whereas older age (AOR: 0.35 [0.15-0.85], p = 0.020 for age 2-5 years), night sweats (AOR: 0.24 [0.10-0.60], p = 0.0022) and acute malnutrition (AOR: 0.36 [0.14-0.92], p = 0.034) were associated with a delayed diagnosis. The case fatality rate was 9% (2/22) in CLHIV and 4% (6/135) in children without HIV, p = 0.31.
Conclusions:
These results altogether advocate for better integration of TB services into all pediatric entry points with a special focus on nutrition services, and illustrate the importance of non-sputum-based TB diagnostics especially in CLHIV.
Trial Registration:
NCT03862261, first registration 05/03/2019.
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