Use of antiretrovirals in HIV-infected children in a tuberculosis prevention trial: IMPAACT P1041

B. Zeldow, Soyeon Kim, George McSherry, M. F. Cotton, P. Jean-Philippe, A. Violari, R. Bobat, S. Nachman, L. M. Mofenson, S. A. Madhi, C. Mitchell

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Abstract

SETTING: International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1041, a tuberculosis (TB) prevention trial conducted among children enrolled from 2004 to 2008 during South Africa's roll-out of combination antiretroviral therapy (ART). OBJECTIVE: To estimate TB incidence and mortality and the effect of ART. DESIGN: Children were pre-screened to exclude TB disease and exposure, actively screened 3-monthly for TB exposure and symptoms, and provided post-exposure isoniazid prophylaxis therapy (IPT). TB diagnoses were definite, probable, or possible, and mortality all-cause. Testing was at the 5% significance level. RESULTS: In 539 children (aged 3-4 months) followed up for a median of 74 weeks (interquartile range [IQR] 48-116), incidence/100 person-years (py) was 10.67 (95%CI 8.47-13.26) for any TB and 2.89 (95%CI 1.85-4.31) for definite/probable TB. Any TB incidence was respectively 9.39, 13.59, and 9.83/100 py before, <180 days after, and ≥180 days after ART initiation. Adjusted analysis showed a non-significant increase in any TB (HR 1.32, 95%CI 0.71-2.52, P = 0.38) and a significant reduction in mortality (HR 0.39, 95%CI 0.17-0.82, P = 0.017) following ART initiation. CONCLUSIONS: ART reduced mortality but not TB incidence in human immunodeficiency virus (HIV) infected children in IMPAACT P1041, possibly attributable to active screening for TB exposure and symptoms with post-exposure IPT. Research into this as a strategy for TB prevention in high HIV-TB burden settings may be warranted.

Original languageEnglish (US)
Pages (from-to)38-45 and i-iii
JournalInternational Journal of Tuberculosis and Lung Disease
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2017

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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    Zeldow, B., Kim, S., McSherry, G., Cotton, M. F., Jean-Philippe, P., Violari, A., Bobat, R., Nachman, S., Mofenson, L. M., Madhi, S. A., & Mitchell, C. (2017). Use of antiretrovirals in HIV-infected children in a tuberculosis prevention trial: IMPAACT P1041. International Journal of Tuberculosis and Lung Disease, 21(1), 38-45 and i-iii. https://doi.org/10.5588/ijtld.16.0149