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Human immunodeficiency virus infection in children hospitalised with tuberculosis
Heleen J Blussé van Oud-Alblas1, Margreet E van Vliet, Jan L L Kimpen
1Utrecht University Medical Centre, Utrecht, The Netherlands.
Insights
HIV infection significantly worsens tuberculosis outcomes in children, increasing mortality and drug resistance. Early diagnosis and integrated care are crucial for managing pediatric TB in co-infected populations.
Area of Science:
- Pediatric infectious diseases
- Clinical microbiology
- Public health
Background:
- Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection is a significant global health challenge, particularly in children.
- Understanding the interplay between HIV and TB presentation, and outcomes in pediatric populations is critical for effective management.
Purpose of the Study:
- To investigate the impact of HIV infection on the clinical presentation and outcomes of tuberculosis in hospitalized children.
- To analyze TB disease patterns, tuberculin reactivity, drug resistance, and mortality in HIV-infected versus non-HIV-infected children.
Main Methods:
- A retrospective review of clinical data from children hospitalized with TB at Brooklyn Hospital for Chest Diseases between January 1998 and December 1999.
- Data extraction from a prospectively compiled patient register, including HIV status, TB clinical presentation, tuberculin skin test results, Mycobacterium tuberculosis culture, drug sensitivity testing, and mortality.
Main Results:
- HIV-infected children showed a higher incidence of pulmonary TB (97%) compared to non-HIV-infected children (85%).
- Tuberculin reactivity was significantly lower in HIV-infected children (31%) versus non-HIV-infected (72%).
- Mortality was substantially higher in HIV-infected children (17%) compared to non-HIV-infected children (2%), with drug resistance (INH and RMP) also noted in co-infected individuals.
Conclusions:
- HIV infection is associated with a more severe clinical presentation of TB and poorer outcomes in children.
- Lower tuberculin reactivity in HIV-infected children may complicate TB diagnosis.
- Increased mortality and drug resistance in HIV-TB co-infected children underscore the need for integrated management strategies.
Abstract:
The impact of HIV infection on clinical presentation and outcome of tuberculosis (TB) was studied in children hospitalised at the Brooklyn Hospital for Chest Diseases (BCH), Cape Town over the 2-year period January 1998 to December 1999. Clinical data were extracted from a prospectively compiled patient register. Of 261 children with TB, 114 (median age 24 mths) were not HIV-infected and 36 (median age 23 mths) were HIV-infected. The HIV status of 111 children (median age 37 mths) was not determined. Pulmonary TB with or without extrapulmonary TB occurred in 97 (85%) children who were not HIV-infected, 35 (97%) HIV-infected children and 87 (78%) of those not tested (p = 0.025). A tuberculin reaction > or = 15 mm was elicited in ten (31%) of 32 HIV-infected children, 76 (72%) of 106 non-HIV-infected and 62 (71%) of those not tested (p < 0.001). Mycobacterium tuberculosis was cultured from 116 (49%) of 238 children and drug sensitivity was evaluated in 79. Nine isolates (11%) were resistant to isoniazid (INH) and 11 (14%) to INH and rifampicin (RMP). Two HIV-infected children treated previously in BCH for drug-sensitive TB were re-admitted with INH and RMP resistance. Two (2%) non-HIV-infected children, six (17%) HIV-infected children and one (1%) child with undetermined HIV status died (p < 0.001).