Effect of TB-HIV co-treatment on clinical and growth outcomes among hospitalized children newly initiating antiretroviral therapy

Abstract

Objective: Evaluate effects of TB-HIV co-treatment on clinical and growth outcomes in children with HIV (CHIV). Design: Longitudinal study among Kenyan hospitalized ART-naive CHIV in the PUSH trial (NCT02063880). Methods: CHIV started ART within 2 weeks of enrollment; Anti-TB therapy was initiated based on clinical and TB diagnostics. Children were followed for 6 months with serial viral load, CD4%, and growth assessments (weight-for-age [WAZ], height-for-age [HAZ], and weight-for-height [WHZ]). TB-ART treated and ART-only groups were compared at 6-months post-ART for undetectable viral load [VL] (<40 c/ml), CD4% change, and growth using generalized linear models, linear regression, and linear mixed-effects models, respectively. Result: Among 152 CHIV, 40.8% (62) were TB-ART treated. Pre-ART, median age was 2.0 years and growth was significantly lower, and VL significantly higher in the TB-ART vs. ART-only group. After 6 months on ART, 37.2% of CHIV had undetectable VL and median CD4% increased by 7.2% (IQR 2.0%-11.6%) with no difference between groups. The TB-ART group had lower WAZ and HAZ over 6 month follow-up (WAZ -0.81 [95% CI: -1.23, -0.38], p < 0.001; HAZ -0.15 [95% CI: -0.29, -0.01], p = 0.030) and greater rate of WAZ increase in analyses unadjusted and adjusted for baseline WAZ (unadj 0.62 [95% CI: 0.18, 1.07, p = 0.006] or adj 0.58 [95% CI: 0.12, 1.03, p = 0.013]). Conclusion: TB-HIV co-treatment did not adversely affect early viral suppression and CD4 recovery post-ART. TB-ART treated CHIV had more rapid growth reconstitution, but growth deficits persisted, suggesting need for continued growth monitoring.