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Tuberculosis and HIV co-infections in Jamaican children
M Geoghagen1, J A Farr, I Hambleton
1The Department of Obstetrics, Gynaecology and Child Health, The University of the West Indies, Kingston 7, Jamaica, West Indies.
Insights
Tuberculosis (TB) and HIV co-infection is rising in Jamaican children. HIV-infected children face severe illness and higher mortality, highlighting the need for antiretroviral access and improved public health strategies.
Area of Science:
- Pediatric Infectious Diseases
- Global Public Health
- HIV/AIDS Research
Background:
- Worldwide increase in tuberculosis (TB) prevalence.
- Rising trend of TB in Jamaican children.
- Need for data on pediatric TB and HIV co-infection in developing countries.
Purpose of the Study:
- Determine factors associated with tuberculosis in Jamaican children.
- Compare outcomes of TB in HIV-infected versus HIV-uninfected children.
- Evaluate the impact of HIV co-infection on pediatric TB cases.
Main Methods:
- Retrospective record review of children aged 0-12 years (1999-2002).
- Comparison of associated factors and outcomes between HIV-infected and HIV-uninfected TB cases.
- Use of exact statistical methods and modified WHO criteria for TB diagnosis.
Main Results:
- Significant increase in active TB cases (24 children) from 1999-2002.
- 11 (46%) of TB cases were HIV-infected, primarily via mother-to-child transmission.
- HIV-infected children had longer hospital stays and higher mortality rates (7/11 vs. 2/13).
Conclusions:
- HIV and TB co-infection is a growing concern in Jamaican children.
- HIV-infected children experience more severe illness and greater mortality from TB.
- Urgent need for antiretroviral drug availability, reduced mother-to-child HIV transmission, and strengthened TB public health management.
Background:
There has been a worldwide increased prevalence of tuberculosis (TB) in recent years, with a similar trend observed in Jamaica and more recently in children admitted to the University Hospital of the West Indies, Jamaica. Data regarding paediatric TB, especially as it relates to all aspects of HIV co-infection, are needed from developing countries in diverse geographic settings to enhance prevention and treatment policies (National Institutes of Health, Office of AIDS Research, FY 2005 Budgetary Planning Meeting, March 11, 2003, Washington, DC).
Objective:
To determine associated factors and outcomes of tuberculosis in HIV-infected and noninfected children in Jamaica.
Method:
We reviewed records of children aged 0 - 12 years attending the University Hospital of the West Indies during January 1999 to December 2002. Associated factors and outcomes in HIV-infected and HIV-negative cases with TB were compared using exact statistical methods to account for the small number of children and an adjustment for multiple testing. TB diagnosis was determined using modified World Health Organization (WHO) criteria.
Results:
There was a significant increase of active TB cases from 1999 to 2002 with 24 children diagnosed over this period All 24 children (100%) had received the Bacillus-Calmette-Guerin (BCG) vaccine. Eleven (46%) of these were HIV-infected, all via mother-to-child transmission. HIV-infected children were statistically more likely to be older than non-infected children (mean 4.2 vs 2.6 years), and also to have failure to thrive, digital clubbing, hepatomegaly, splenomegaly, generalized adenopathy and negative Mantoux tests. Appropriate in-hospital anti-TB therapy was given. Hospital stay was longer (median 7.4 vs. 2.8 months) and death was more likely (7/11 vs 2/13) in HIV-infected vs non-infected children. Triple antiretroviral therapy was given in three of the 11 HIV-infected cases and this markedly improved outcome. Household family members with active TB were identified in twelve cases.
Conclusions:
HIV and TB co-infection is an increasing problem in Jamaican children. Severity of illness and death is greater in HIV-infected children, despite appropriate anti-TB therapy. Antiretroviral drugs must be made available to this population. Efforts must be enhanced to reduce mother-to-child-transmission of HIV/AIDS and to strengthen the public health management of TB (contact tracing and completion of TB therapy by directly observed therapy) to eliminate the spread
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