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Treatment Outcomes of Children With HIV Infection and Drug-resistant TB in Three Provinces in South Africa, 2005–2008

Hall, Eric, W., MPH*; Morris, Sapna, B., MD; Moore, Brittany, K., MPH; Erasmus, Linda, PhD; Odendaal, Ronel, MSc§; Menzies, Heather, MD; van der Walt, Martie, PhD§; Smith, Sarah, E., MPH

The Pediatric Infectious Disease Journal: December 2017 - Volume 36 - Issue 12 - p e322–e327
doi: 10.1097/INF.0000000000001691
HIV Reports

Objective: To describe outcomes of HIV-infected pediatric patients with drug-resistant tuberculosis (DR TB).

Methods: Demographic, clinical and laboratory data from charts of pediatric patients treated for DR TB during 2005–2008 were collected retrospectively from 5 multi-DR TB hospitals in South Africa. Data were summarized, and Pearson χ2 test or Fisher exact test was used to assess differences in variables of interest by HIV status. A time-to-event analysis was conducted using days from start of treatment to death. Variables of interest were first assessed using the Kaplan-Meier method. Cox proportional hazard models were fit to estimate crude and adjusted hazard ratios.

Results: Of 423 eligible participants, 398 (95%) had culture-confirmed DR TB and 238 (56%) were HIV infected. A total of 54% were underweight, 42% were male and median age was 10.7 years (interquartile range: 5.5–15.3). Of the 423 participants, 245 (58%) were successfully treated, 69 (16%) died, treatment failed in 3 (1%), 36 (9%) were lost to follow-up and 70 (17%) were still on treatment, transferred or had unknown outcomes. Time to death differed by HIV status (P = 0.008), sex (P < 0.001), year of tuberculosis diagnosis (P = 0.05) and weight status (P = 0.002). Over the 2-year risk period, the adjusted rate of death was 2-fold higher among participants with HIV compared with HIV-negative participants (adjusted hazard ratio = 2.28; 95% confidence interval: 1.11–4.68).

Conclusions: Male, underweight and HIV-infected children with DR TB were more likely to experience death when compared with other children with DR TB within this study population.

From the *Department of Epidemiology, Emory University, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; and §South African Medical Research Council, Pretoria, South Africa.

Accepted for publication January 11, 2017.

This evaluation was supported with funding provided by the US Agency for International Development and the US Centers for Disease Control and Prevention, with additional support from the South Africa National Institute for Communicable Diseases of the National Health Laboratory Service and the South African Medical Research Council (Cooperative Agreement U23-CCU021809 FOA No. PS-07-006).

The authors have no conflicts of interest to disclose.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Eric Hall, MPH, Emory University, 1518 Clifton Rd, GCR 432, Atlanta, GA 30322. E-mail: eric.w.hall@emory.edu.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.