Abstract:
Globally, 1.8 million HIV infected children live with HIV; nearly 53% of them were receiving HIV
treatment. People who are infected with HIV are 18 times more likely to develop active TB. Despite
antiretroviral treatment has shown marked reduction in TB incidence, TB continues to occur in
Sub-Saharan countries including Ethiopia among HIV infected people. The effect of highly active
antiretroviral treatment is quite successful in developed countries. However, in developing country TB/
HIV co-infection remains perplexing among children on the treatment. The aim of this study was to
investigate the impact of ART on the incidence of TB among Children infected with HIV in Southwest
Ethiopia. A retrospective cohort study was conducted on randomly selected 800 samples from ART
clinic between 2009 and 2014. We used chi-square test, and Mann–Whitney U test to compare HAART
naïve and HAART cohort. We used marginal structural models to estimate the effect of HAART on
survival while accounting for time-dependent confounders affected by exposure. A total of 800
children were followed for 2942.99 child-years. The children were observed for a median of 51 months
with IQR 31 and for a total of 2942.99 child-years. From 506 OIs that occurred, the most common
reported OIs were Pneumonia (22%) and TB (23.6%). The overall TB incidence rate was 7.917 per 100
child years (95% CI, 6.933–9.002). Whereas among HAART (7.667 per 100-years (95% CI, 6.318–9.217)
and 8.1686 per 100 person-years (95% CI 6.772–9.767) for HAART naïve. The mortality hazard ratio
comparing HAART with no HAART from a marginal structural model was 0.642 (95% CI 0.442–0.931,
p < 0.02). HAART reduced the hazard of TB in HIV-infected children by 36%. This is by far less than
expected.
