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Kassaw A, Asferie WN, Azmeraw M, Kefale D, Kerebih G, Mekonnen GB, Baye FD, Zeleke S, Beletew B, Kebede SD, Aytenew TM, Bazezew LY, Agimas MC. Incidence and predictors of tuberculosis among HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0306651. [PMID: 38968268 PMCID: PMC11226042 DOI: 10.1371/journal.pone.0306651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/20/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Globally, Tuberculosis (TB) is the main cause of morbidity and mortality among infectious disease. TB and Human Immune Virus (HIV) are the two deadly pandemics which interconnected each other tragically, and jeopardize the lives of children; particularly in Sub-Saharan Africa. Therefore, this review was aimed to determine the aggregated national pooled incidence of tuberculosis among HIV- infected children and its predictors in Ethiopia. METHODS An electronic search engine (HINARI, PubMed, Scopus, web of science), Google scholar and free Google databases were searched to find eligible studies. Quality of the studies was checked using the Joanna Briggs Institute (JBI) quality assessment checklists for cohort studies. Heterogeneity between studies was evaluated using Cochrane Q-test and the I2 statistics. RESULT This review revealed that the pooled national incidence of tuberculosis among children with HIV after initiation of ART was 3.63% (95% CI: 2.726-4.532) per 100-person-years observations. Being Anemic, poor and fair ART adherence, advanced WHO clinical staging, missing of cotrimoxazole and isoniazid preventing therapy, low CD4 cell count, and undernutrition were significant predictors of tuberculosis incidence. CONCLUSION The study result indicated that the incidence of TB among HIV- infected children is still high. Therefore, parents/guardians should strictly follow and adjust nutritional status of their children to boost immunity, prevent undernutrition and opportunistic infections. Cotrimoxazole and isoniazid preventive therapy need to continually provide for HIV- infected children for the sake of enhancing CD4/immune cells, reduce viral load, and prevent from advanced disease stages. Furthermore, clinicians and parents strictly follow ART adherence.
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Affiliation(s)
- Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molla Azmeraw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Kerebih
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrehiwot Berie Mekonnen
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fikadie Dagnew Baye
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shegaw Zeleke
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Beletew
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Solomon Demis Kebede
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye Aytenew
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Lakachew Yismaw Bazezew
- Department of Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kay A, Mendez-Reyes J, Devezin T, Bakaya M, Steffy T, Dlamini S, Msekandiana A, Ness T, Bacha J, Amuge P, Matshaba M, Chodota M, Nyasulu P, Thahane L, Mwita L, Kekitiinwa A, DiNardo A, Lukhele B, Kirchner HL, Mandalakas A. Optimal Timing of Antiretroviral Therapy Initiation in Children and Adolescents With Human Immunodeficiency Virus-Associated Pulmonary Tuberculosis. Clin Infect Dis 2022; 76:10-17. [PMID: 36097966 PMCID: PMC9825818 DOI: 10.1093/cid/ciac765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There is insufficient evidence in children and adolescents with human immunodeficiency virus (CAHIV) to guide the timing of antiretroviral treatment (ART) initiation after starting treatment for pulmonary tuberculosis (pTB). To address this knowledge gap, we evaluated the risk of mortality associated with timing of ART initiation in ART-naive CAHIV treated for pTB. METHODS Data were extracted from electronic medical records of ART-naive patients, aged 0-19 years, who were treated for HIV-associated pTB at Baylor Centers of Excellence in Botswana, Eswatini, Malawi, Lesotho, Tanzania, or Uganda between 2013 and 2020. Data were analyzed against a primary outcome of all-cause mortality with unadjusted Kaplan-Meier curves and Cox proportional hazard models. RESULTS The study population included 774 CAHIV with variable intervals to ART initiation after starting TB treatment: <2 weeks (n = 266), 2 weeks to 2 months (n = 398), >2 months (n = 66), and no ART initiated (n = 44). Adjusted Cox proportional hazards models demonstrated increased mortality 1 year from TB treatment initiation in children never starting ART (adjusted HR [aHR]: 2.67; 95% CI: 1.03, 6.94) versus children initiating ART between 2 weeks and 2 months from TB treatment initiation. Mortality risk did not differ for the <2-weeks group (aHR: 1.02; 95% CI: .55, 1.89) versus the group initiating ART between 2 weeks and 2 months. CONCLUSIONS This retrospective study demonstrated no increase in mortality among CAHIV initiating ART <2 weeks from TB treatment initiation. Given the broad health benefits of ART, this evidence supports the recent WHO recommendation for CAHIV to initiate ART within 2 weeks of initiating TB treatment.
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Affiliation(s)
- Alexander Kay
- Correspondence: A. Kay, Baylor College of Medicine, Associate Director of the Baylor College of Medicine Global TB Program, Baylor College of Medicine Children's Foundation Eswatini, PO Box 110, Mbabane H-100, Eswatini or Baylor College of Medicine, 1102 Bates St, FC-630, Houston, TX 77030, USA ()
| | - Jose Mendez-Reyes
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Tara Devezin
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Meenakshi Bakaya
- Baylor College of Medicine Children's Foundation–Lesotho, Maseru, Lesotho
| | - Teresa Steffy
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation–Lesotho, Maseru, Lesotho
| | - Sandile Dlamini
- Baylor College of Medicine Children's Foundation–Swaziland, Mbabane, Eswatini
| | - Amos Msekandiana
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Tara Ness
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Jason Bacha
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children’s Foundation–Tanzania, Mbeya, Tanzania
| | - Pauline Amuge
- Baylor College of Medicine Children's Foundation–Uganda, Kampala, Uganda
| | - Mogomotsi Matshaba
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Moses Chodota
- Baylor College of Medicine Children’s Foundation–Tanzania, Mbeya, Tanzania
| | - Phoebe Nyasulu
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Lineo Thahane
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation–Lesotho, Maseru, Lesotho
| | - Lumumbwa Mwita
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation–Tanzania, Mwanza, Tanzania
| | - Adeodata Kekitiinwa
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation–Uganda, Kampala, Uganda
| | - Andrew DiNardo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Bhekumusa Lukhele
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation–Swaziland, Mbabane, Eswatini
| | - H Lester Kirchner
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Anna Mandalakas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Research Center Borstel, Clinical Infectious Diseases, Borstel, Germany
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Kay AW, Rabie H, Maleche-Obimbo E, Sekadde MP, Cotton MF, Mandalakas AM. HIV-Associated Tuberculosis in Children and Adolescents: Evolving Epidemiology, Screening, Prevention and Management Strategies. Pathogens 2021; 11:33. [PMID: 35055981 PMCID: PMC8780758 DOI: 10.3390/pathogens11010033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Children and adolescents living with HIV continue to be impacted disproportionately by tuberculosis as compared to peers without HIV. HIV can impact TB screening and diagnosis by altering screening and diagnostic test performance and can complicate prevention and treatment strategies due to drug-drug interactions. Post-tuberculosis lung disease is an underappreciated phenomenon in children and adolescents, but is more commonly observed in children and adolescents with HIV-associated tuberculosis. This review presents new data related to HIV-associated TB in children and adolescents. Data on the epidemiology of HIV-associated TB suggests that an elevated risk of TB in children and adolescents with HIV persists even with broad implementation of ART. Recent guidance also indicates the need for new screening strategies for HIV-associated TB. There have been major advances in the availability of new antiretroviral medications and also TB prevention options for children, but these advances have come with additional questions surrounding drug-drug interactions and dosing in younger age groups. Finally, we review new approaches to manage post-TB lung disease in children living with HIV. Collectively, we present data on the rapidly evolving field of HIV-associated child tuberculosis. This evolution offers new management opportunities for children and adolescents living with HIV while also generating new questions for additional research.
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Affiliation(s)
- Alexander W. Kay
- Global Tuberculosis Program, Department of Pediatrics, Baylor College of Medicine and Texas Chidlren’s Hospital, Houston, TX 77030, USA;
| | - Helena Rabie
- Department of Pediatrics and Child Health and FAMCRU, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa;
| | | | | | - Mark F. Cotton
- Children’s Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Anna M. Mandalakas
- Global Tuberculosis Program, Department of Pediatrics, Baylor College of Medicine and Texas Chidlren’s Hospital, Houston, TX 77030, USA;
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Kaguthi G, Nduba V, Rabuogi P, Okelloh D, Ouma SG, Blatner G, Gelderbloem S, Mitchell EMH, Scott CP, Verver S, Hawkridge T, de Steenwinkel JEM, Laserson KF, Richardus JH. Development of a TB vaccine trial site in Africa and lessons from the Ebola experience. BMC Public Health 2020; 20:999. [PMID: 32586316 PMCID: PMC7316575 DOI: 10.1186/s12889-020-09051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis is the deadliest infection of our time. In contrast, about 11,000 people died of Ebola between 2014 and 2016. Despite this manifest difference in mortality, there is now a vaccine licensed in the United States and by the European Medicines Agency, with up to 100% efficacy against Ebola. The developments that led to the trialing of the Ebola vaccine were historic and unprecedented. The single licensed TB vaccine (BCG) has limited efficacy. There is a dire need for a more efficacious TB vaccine. To deploy such vaccines, trials are needed in sites that combine high disease incidence and research infrastructure. We describe our twelve-year experience building a TB vaccine trial site in contrast to the process in the recent Ebola outbreak. There are additional differences. Relative to the Ebola pipeline, TB vaccines have fewer trials and a paucity of government and industry led trials. While pathogens have varying levels of difficulty in the development of new vaccine candidates, there yet appears to be greater interest in funding and coordinating Ebola interventions. TB is a global threat that requires similar concerted effort for elimination.
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Affiliation(s)
- G Kaguthi
- Centre for Respiratory Diseases Research-Kenya Medical Research Institute (KEMRI-CRDR), Nairobi, Kenya. .,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,(at the time of the studies) KEMRI and Centers for Disease Control and Prevention Public Health Collaboration, Kisumu, Kenya.
| | - V Nduba
- Centre for Respiratory Diseases Research-Kenya Medical Research Institute (KEMRI-CRDR), Nairobi, Kenya.,(at the time of the studies) KEMRI and Centers for Disease Control and Prevention Public Health Collaboration, Kisumu, Kenya
| | - P Rabuogi
- Centre for Respiratory Diseases Research-Kenya Medical Research Institute (KEMRI-CRDR), Nairobi, Kenya.,(at the time of the studies) KEMRI and Centers for Disease Control and Prevention Public Health Collaboration, Kisumu, Kenya
| | - D Okelloh
- Centre for Respiratory Diseases Research-Kenya Medical Research Institute (KEMRI-CRDR), Nairobi, Kenya.,(at the time of the studies) KEMRI and Centers for Disease Control and Prevention Public Health Collaboration, Kisumu, Kenya
| | - S G Ouma
- Centre for Respiratory Diseases Research-Kenya Medical Research Institute (KEMRI-CRDR), Nairobi, Kenya.,(at the time of the studies) KEMRI and Centers for Disease Control and Prevention Public Health Collaboration, Kisumu, Kenya
| | - G Blatner
- AERAS (at the time of the studies), Cape Town, South Africa.,AERAS (at the time of the studies), Rockville, Maryland, USA
| | - S Gelderbloem
- AERAS (at the time of the studies), Cape Town, South Africa.,AERAS (at the time of the studies), Rockville, Maryland, USA
| | - Ellen M H Mitchell
- Institute of Tropical Medicine, Antwerp, Belgium.,(at the time of the studies) KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Cherise P Scott
- AERAS (at the time of the studies), Cape Town, South Africa.,AERAS (at the time of the studies), Rockville, Maryland, USA
| | - S Verver
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,(at the time of the studies) KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - T Hawkridge
- AERAS (at the time of the studies), Cape Town, South Africa.,AERAS (at the time of the studies), Rockville, Maryland, USA
| | - J E M de Steenwinkel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - K F Laserson
- (at the time of the studies) KEMRI and Centers for Disease Control and Prevention Public Health Collaboration, Kisumu, Kenya
| | - J H Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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