Mortality and its determinants in antiretroviral treatment-naive HIV-infected children with suspected tuberculosis: an observational cohort study
2017; Elsevier BV; Volume: 5; Issue: 2 Linguagem: Inglês
10.1016/s2352-3018(17)30206-0
ISSN2405-4704
AutoresOlivier Marcy, Mathurin Cyrille Tejiokem, Philippe Msellati, Khanh Truong Huu, Viet Chau, Duong Tran Ngoc, Boubacar Nacro, Francis Ateba-Ndongo, Suzie Tetang-Ndiang, Ung Vibol, Bunnet Dim, Leakhena Neou, Laureline Berteloot, Laurence Borand, Christophe Delacourt, Stéphane Blanche, Sao Sarady Ay, Laurence Borand, Malen Chan, Phalla Chea, Bunnet Dim, Sophie Goyet, Olivier Marcy, Nimul Roat Men, Phearavin Pheng, Susan Ramsay, Sophea Suom, Arnaud Tarantola, Naisim Te, S Than, Sovannary Ung, Chorn Chhuk, Chantheany Huot, Sang Han Kath, Sokoeun Khin, Peou Kim, Kim Eng Lim, Phary Lim, Vannareth Lim, Yany Nav, Boren Pich, Sotharin Tuy, Ung Vibol, Phal Chea, Sengtray Chhraing, Bophal Chuop, Ramy Hem, Phanoeurn Heng, S Huon, Sokhorn Khum, Thear Liv, Vichea Ly, Makara Moch, Leakheana Neou, Phanith Rey, Vina Sath, Nopheavann Sun, Pheron Chat, Viso Srey, Sitha Chheang, Hor Putchhat, Manory Oum, Monorea Keo, Sokchea Kou, Sokleaph Cheng, Alexandra Kerléguer, Michel Kiréopori Gomgnimbou, Antoinette Kaboré, A Millogo, Boubacar Nacro, Zakari Nikièma, Abdul Salam Ouedraogo, Sawadogo Saidou, Moumini Nouctara, Diane Ursule Sangare Ouattara, Bintou Sanogo, Edgard Sib Sié, Dezémon Zingué, Roger Ngoya Abiguide, Patrice Assene Ngo'o, Francis Atéba Ndongo, Suzanne Balla, Verlaine Bolyse Mbouchong, Jean Marie Ehongo Amanya, Sara Eyangoh, Kaiyven Afi Leslie, Paul Koki Ndombo, Samuel Walter Kokola Bayanak, Marie Josée Mapah Kampaing, Elizabeth Mangoya, Minkala Mvogo, Jean Pierre Ndongo, Laurence Tchouasseu N’gassam, Francine Nanda, Sylviane Ndjantou, Jean Audrey Ndongo, Marcelle Njind Nkoum, Anne Esther Njom Lend, Angeline Nkembe, Marie Flore Oyanche, Jean-Voisin Taguebue, Mathurin Cyrille Tejiokem, Suzy Tetang-Moyo, Sylvie Georgette Zebaze, Thi Oanh Nguyen, Thi Ngoc Lan Nguyen, Catherine Quillet, Khanh Lê Quoc, My Huong To, Thi Kim Phung Tran, Chau Giang, Duc Bang Nguyen, N. Nguyen, Thi Hieu Nguyen, Thi Thanh Thanh Nguyen, Ngoc Tran, Duy An Vo, Thi Xuan Lan Dang, Thi Kim Phuong, Thi Thanh Tuyen Dang, Hoang Chau Nguyen, Ngoc Tuong Vy Pham, Huu Khanh Truong, Chau Viet, Bich Ngoc Huynh, Thi Thanh Thuy Le, Thi Thu Hiep Nguyen, Ngoc Luu Tran, Thien An Vu, Huu Loc Tran, Manh Hoang Nguyen, Ngoc Lan Nguyen, Thi Cao Van Nguyen, Thu Hang Pham, Dinh Quyen Phan, Thi Ha Vo, Xuan Lien Truong, Xuan Thinh Vu, Stéphane Blanche, Christophe Delacourt, Laureline Berteloot, Guislaine Carcelain, Sylvain Godreuil, Isabelle Fournier-Nicolle,
Tópico(s)HIV/AIDS Research and Interventions
ResumoTuberculosis is a major cause of morbidity and mortality in HIV-infected children, but is difficult to diagnose. We studied mortality and its determinants in antiretroviral treatment (ART)-naive HIV-infected children presenting with suspected tuberculosis.In this observational cohort study, HIV-infected children aged 13 years or younger with suspected tuberculosis were followed up for 6 months as part of the ANRS 12229 PAANTHER 01 cohort in eight hospitals in four countries (Burkina Faso, Cambodia, Cameroon, and Vietnam). Children started ART and antituberculosis treatment at the clinician's discretion and were retrospectively classified into one of three groups by tuberculosis documentation: confirmed by culture or Xpert MTB/RIF, unconfirmed, and unlikely. We assessed mortality and associated factors using Kaplan-Meier methods and Cox proportional hazard models. The ANRS 12229 PAANTHER 01 study is registered at ClinicalTrials.gov, number NCT01331811.266 (61%) of 438 children enrolled in the study between April 27, 2011, and May 31, 2014, were ART-naive and included in the analysis (40 had confirmed tuberculosis, 119 unconfirmed tuberculosis, and 107 unlikely tuberculosis). 112·5 person-years of follow-up were available. 154 children (58%) started antituberculosis treatment and 212 (80%) started ART. 50 children (19%) died. Mortality by 6 months was higher in children with confirmed tuberculosis (14 deaths; 2 month survival probability 65·0% [95% CI 50·2-79·8]) compared with unconfirmed tuberculosis (19 deaths; 83·5% [76·8-90·3]) and unlikely tuberculosis (17 deaths; 83·5% [76·3-90·7]; log-rank p=0·0141) and was lower in children with confirmed or unconfirmed tuberculosis who started antituberculosis treatment (p<0·0001 for both). In a multivariate analysis, ART started during the first month of follow-up (hazard ratio 0·08; 95% CI 0·01-0·67), confirmed tuberculosis (6·33; 2·15-18·64), young age (5·90; 2·02-17·19), CD4 less than 10% (2·63; 1·25-5·53), miliary features (4·08; 1·56-10·66), and elevated serum transaminases (4·40; 1·82-10·65) were all independently associated with mortality.In our cohort, mortality was high in the first 6 months after suspicion of tuberculosis in ART-naive children. ART should be started early, particularly in children with factors associated with high mortality. Documented or empirical tuberculosis treatment decision should be accelerated to reduce mortality and allow early ART initiation.ANRS and Fondation Total.
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