@article{fdi:010072330,
  title = {{M}ortality and its determinants in antiretroviral treatment-naive {HIV}-infected children with suspected tuberculosis : an observational cohort study},
  author = {{M}arcy, {O}. and {T}ejiokem, {M}. and {M}sellati, {P}hilippe and {H}uu, {K}. {T}. and {C}hau, {V}. {D}. and {N}goc, {D}. {T}. and {N}acro, {B}. and {A}teba-{N}dongo, {F}. and {T}etang-{N}diang, {S}. and {U}ng, {V}. and {D}im, {B}. and {N}eou, {L}. and {B}erteloot, {L}. and {B}orand, {L}. and {D}elacourt, {C}. and {B}lanche, {S}. and {ANRS} {P}aanther {S}tudy {G}roup,},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {T}uberculosis is a major cause of morbidity and mortality in {HIV}-infected children, but is difficult to diagnose. {W}e studied mortality and its determinants in antiretroviral treatment ({ART})-naive {HIV}-infected children presenting with suspected tuberculosis. {M}ethods {I}n 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 ({B}urkina {F}aso, {C}ambodia, {C}ameroon, and {V}ietnam). {C}hildren 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 {X}pert {MTB}/{RIF}, unconfirmed, and unlikely. {W}e assessed mortality and associated factors using {K}aplan-{M}eier methods and {C}ox proportional hazard models. {T}he {ANRS} 12229 {PAANTHER} 01 study is registered at {C}linical{T}rials. gov, number {NCT}01331811. {F}indings 266 (61%) of 438 children enrolled in the study between {A}pril 27, 2011, and {M}ay 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. {M}ortality 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). {I}n 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), {CD}4 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. {I}nterpretation {I}n 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. {D}ocumented or empirical tuberculosis treatment decision should be accelerated to reduce mortality and allow early {ART} initiation.},
  keywords = {{BURKINA} {FASO} ; {CAMBODGE} ; {CAMEROUN} ; {VIET} {NAM}},
  booktitle = {},
  journal = {{L}ancet {HIV}},
  volume = {5},
  numero = {2},
  pages = {{E}87--{E}95},
  ISSN = {2352-3018},
  year = {2018},
  DOI = {10.1016/s2352-3018(17)30206-0},
  URL = {https://www.documentation.ird.fr/hor/fdi:010072330},
}