1. A treatment-decision score for HIV-infected children with suspected tuberculosis
- Author
-
Francis Ateba-Ndongo, Mathurin Cyrille Tejiokem, Bunnet Dim, Philippe Msellati, Duong Ngoc Tran, Laureline Berteloot, Bintou Sanogo, Isabelle Fournier, Stéphane Blanche, Catherine Quillet, Guislaine Carcelain, Laurence Borand, Sylvain Godreuil, Vibol Ung, Viet Do Chau, Khanh Truong Huu, Polidy Pean, Leakhena Neou, Suzie Tetang-Ndiang, Olivier Marcy, Christophe Delacourt, Boubacar Nacro, Sophie Goyet, Unité d'Épidémiologie et de Santé Publique [Phnom Penh], Institut Pasteur du Cambodge, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Health Sciences [Phnom-Penh, Cambodia] (UHS), Tuberculosis and HIV Department [Phnom Penh, Cambodia], National pediatric hospital [Phnom Penh, Cambodge] (NPH), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Laboratoire d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Benh Vien Nhi Dong 1 Children's Hospital [Vietnam], Pham Ngoc Thach Hospital, Centre Mère et Enfant de la Fondation Chantal Biya, Centre international de référence Chantal Biya pour la recherche sur la prévention et la prise en charge du VIH/SIDA (CIRCB), Fondation Chantal Biya (FCB)-Fondation Chantal Biya (FCB), Centre Hospitalier Essos [Yaoundé, Cameroun], Centre Hospitalier Universitaire Souro Sanou [Bobo-Dioulasso] (CHUSS), Unité d'Immunologie Hématologie et Rhumatologie Pédiatrique [Necker, Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Angkor Hospital for Children (AHC), Immunologie [Phnom Penh], ANRS Research Site [Ho Chi Minh City, Vietnam], Essais Thérapeutiques et Maladies Infectieuses, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de radiologie pédiatrique [CHU Necker], Service Immunologie Biologique [Paris], AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Bactériologie-Virologie [Montpellier], Hôpital Arnaud de Villeneuve-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1), Service de Pneumologie et d'Allergologie Pédiatriques, Funded by the ANRS (ANRS 12229) and Fondation Total., and We thank all children and their parents and caregivers for their participation in the study, national tuberculosis and HIV programs from participating countries for their support, Françoise Barré-Sinoussi and Jean-François Delfraissy for their continuous support, Xavier Anglaret for general guidance, Julien Asselineau and Paul Perez for methodologic advice, and Corine Chazallon and Vincent Bouteloup for statistical support.
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Miliary tuberculosis ,Tuberculosis ,Antitubercular Agents ,Infectious Disease ,HIV Infections ,Sensitivity and Specificity ,QuantiFERON ,03 medical and health sciences ,0302 clinical medicine ,Tuberculosis diagnosis ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,030225 pediatrics ,Clinical Decision Rules ,Abdomen ,medicine ,Humans ,030212 general & internal medicine ,Child ,Lung ,Receptors, Interferon ,Ultrasonography ,Bacteriological Techniques ,Microscopy ,medicine.diagnostic_test ,Receiver operating characteristic ,AIDS-Related Opportunistic Infections ,business.industry ,Reproducibility of Results ,medicine.disease ,3. Good health ,Radiography ,Abdominal ultrasonography ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Commentary ,HIV/AIDS ,Female ,Sample collection ,business ,Chest radiograph - Abstract
BACKGROUND: Diagnosis of tuberculosis should be improved in children infected with HIV to reduce mortality. We developed prediction scores to guide antituberculosis treatment decision in HIV-infected children with suspected tuberculosis. METHODS: HIV-infected children with suspected tuberculosis enrolled in Burkina Faso, Cambodia, Cameroon, and Vietnam (ANRS 12229 PAANTHER 01 Study), underwent clinical assessment, chest radiography, Quantiferon Gold In-Tube (QFT), abdominal ultrasonography, and sample collection for microbiology, including Xpert MTB/RIF (Xpert). We developed 4 tuberculosis diagnostic models using logistic regression: (1) all predictors included, (2) QFT excluded, (3) ultrasonography excluded, and (4) QFT and ultrasonography excluded. We internally validated the models using resampling. We built a score on the basis of the model with the best area under the receiver operating characteristic curve and parsimony. RESULTS: A total of 438 children were enrolled in the study; 251 (57.3%) had tuberculosis, including 55 (12.6%) with culture- or Xpert-confirmed tuberculosis. The final 4 models included Xpert, fever lasting >2 weeks, unremitting cough, hemoptysis and weight loss in the past 4 weeks, contact with a patient with smear-positive tuberculosis, tachycardia, miliary tuberculosis, alveolar opacities, and lymph nodes on the chest radiograph, together with abdominal lymph nodes on the ultrasound and QFT results. The areas under the receiver operating characteristic curves were 0.866, 0.861, 0.850, and 0.846, for models 1, 2, 3, and 4, respectively. The score developed on model 2 had a sensitivity of 88.6% and a specificity of 61.2% for a tuberculosis diagnosis. CONCLUSIONS: Our score had a good diagnostic performance. Used in an algorithm, it should enable prompt treatment decision in children with suspected tuberculosis and a high mortality risk, thus contributing to significant public health benefits.
- Published
- 2019
- Full Text
- View/download PDF