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Int J Tuberc Lung Dis. 2013 Nov;17(11):1389-95. doi: 10.5588/ijtld.13.0030.

Risk factors for mortality in Malawian children with human immunodeficiency virus and tuberculosis co-infection.

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Abbott Fund Children's Clinical Centre of Excellence, Baylor College of Medicine, Lilongwe, Malawi; Baylor College of Medicine International Pediatric AIDS Initiative, Houston, Texas, USA; Department of Pediatrics, Denver Health/University of Colorado, Denver, Colorado, USA.



A large urban pediatric human immunodeficiency virus (HIV) clinic in Lilongwe, Malawi.


To identify demographic and clinical risk factors for mortality in children co-infected with HIV and tuberculosis (TB).


A retrospective cohort study of HIV-infected children (aged <18 years) enrolled between October 2004 and October 2010 with at least one current or historical TB diagnosis. Descriptive statistics and logistic regression analyses were performed to determine factors associated with mortality.


A total of 1561 patients met the inclusion criteria, representing 32% of patients ever enrolled. Median age at TB diagnosis was 3.8 years (interquartile range 1.5-7.4); 60.9% had severe immune suppression and 47.6% of those with available data had some degree of acute malnutrition at TB diagnosis. Of the 1113 patients with known outcomes, 225 (20.2%) died. Children with TB-HIV co-infection not initiated on antiretroviral therapy (ART) at any time were 8.8 times more likely to die compared to those initiated on ART 0-2 months after initiation of anti-tuberculosis treatment (adjusted OR 8.83, 95%CI 4.42-17.63). Severe immunosuppression and World Health Organization Stage IV were also associated with mortality.


Pediatric TB-HIV co-infection is common and mortality is high in this cohort of Malawian children. Prompt initiation of ART should be emphasized in this high-risk patient population.

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