SURVIVAL AND LOSS TO FOLLOW UP AMONG HIV AND TUBERCULOSIS CO-INFECTED CHILDREN BELOW 3 YEARS OF AGE INITIATING ANTI-TUBERCULOSIS TREATMENT IN WESTERN KENYA
Abstract: The optimal strategy for treating young children co-infected with HIV and tuberculosis is unknown. We compared mortality and loss to follow-up (LTFU) among HIV-infected children aged three years and below who received anti-tuberculosis treatment (anti-TB) and combination antiretroviral therapy (cART) in various sequences. Methods: We conducted retrospective analysis of longitudinal data of HIV-infected children initiating anti-TB at less than 3 years who had not been initiated on cART at anti-TB initiation enrolled in the USAID-Academic Model Providing Access to Healthcare (AMPATH) Partnership in Kenya between 2001 and 2009. Survival outcomes were analyzed by Kaplan-Meier methods. Cox proportional hazard models were used to evaluate the risk factors associated with death or a composite outcome of death and/or LTFU. Results: Of the 365 eligible subjects, 52% were female, 66% were initiated on cART, 15.9% were LTFU and 6.9% died. Sixty-four were initiated on cART less than 8 weeks after starting on anti-TB, 64 between 8-24 weeks, and 237 after 24 weeks. Being female was associated with a higher chance of initiating cART. Children on cART and anti-TB had better survival compared to those not on anti-TB but never on cART, (HR 0.336 95%CI 0.149-0.757). There was no survival or LTFU difference between the three cART initiation timing groups. Conclusions: For young HIV-TB co-infected children, there was no statistical difference in mortality, LTFU or mortality & LTFU when initiation on cART was staggered depending on the severity of clinical or immunologic stage within 8 weeks, 8-24 weeks or after completion of anti-TB. HIV-TB co-infected children on both cART and anti-TB had better survival.
[Nyandiko WM, MBChB, MMed, MPH, Vreeman RC, MD, MSc , Mwangi A, MSc, PhD, Ayaya SO MBChB, MMed, Kiptoon P, MBChB, MMed, Musick B, MSc, Braitstein P, PhD, Abuya JM, MBChB, MMed Koech J, Msc, Carter J, MD, Hogan J, PhD (2014); SURVIVAL AND LOSS TO FOLLOW UP AMONG HIV AND TUBERCULOSIS CO-INFECTED CHILDREN BELOW 3 YEARS OF AGE INITIATING ANTI-TUBERCULOSIS TREATMENT IN WESTERN KENYA Int. J. of Adv. Res. 2 (8). 0] (ISSN 2320-5407). www.journalijar.com
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