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HAART and risk of tuberculosis in HIV-infected South African children: a multi-site retrospective cohort
Neil A Martinson1, H Moultrie, R van Niekerk
1Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa. martinson@hivsa.com
Insights
Highly active antiretroviral therapy (HAART) significantly reduced tuberculosis (TB) incidence in HIV-infected children in South Africa. Further research is needed to improve TB prevention and diagnosis in this vulnerable population.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Research
- Tuberculosis Epidemiology
Background:
- Human immunodeficiency virus (HIV) infection increases the risk of tuberculosis (TB) in children.
- High TB burden in South Africa necessitates understanding TB incidence in HIV-infected children.
- Effectiveness of highly active antiretroviral therapy (HAART) in preventing TB in pediatric populations requires further investigation.
Purpose of the Study:
- To evaluate the impact of HAART on the incidence of new TB cases among children living with HIV.
- To compare TB incidence rates before and after the initiation of HAART in HIV-infected children.
- To provide data supporting TB prevention strategies in pediatric HIV care.
Main Methods:
- Retrospective cohort study conducted in four South African tertiary hospitals.
- Inclusion of 1132 children's records with HIV infection.
- Analysis of TB incidence rates stratified by pre-HAART and on-HAART periods.
Main Results:
- HAART initiation was associated with a substantial reduction in TB incidence, approximately 70% for both confirmed and all diagnosed TB cases.
- Incidence of clinically diagnosed TB decreased from 21.1 to 6.4 per 100 person-years.
- Microbiologically confirmed TB incidence decreased from 3.1 to 0.8 per 100 person-years with HAART.
Conclusions:
- HAART is effective in reducing incident TB among HIV-infected children in a high TB burden setting.
- TB incidence in HIV-infected children in South Africa is comparable to adult rates.
- Urgent need for prospective studies on TB prevention and improved diagnostics in children with HIV.
Setting:
Four human immunodeficiency virus (HIV) clinics located at South African tertiary hospitals.
Objective:
To assess the effectiveness of highly active antiretroviral therapy (HAART) in reducing incident tuberculosis (TB) in HIV-infected children.
Design:
Retrospective cohort.
Results:
A total of 1132 children's records were included in the study. At entry to the cohort, the median (interquartile range [IQR]) age, CD4%, CD4 count and viral load of all children was respectively 6.3 years (4.1-8.8), 15% (9.0-22.2), 576 cells/mm(3) (287-960) and 160 000 copies/ml (54 941.5-449 683); 75.9% were started on HAART. The male:female ratio was 1:1, and median follow-up time was 1.7 years. In children whose follow-up included both pre-HAART and on-HAART periods, the incidence of clinically diagnosed TB was respectively 21.1 per 100 person-years (py; 95%CI 18.2-24.4) and 6.4/100 py (95%CI 4.8-8.1), and when restricted to confirmed cases, respectively 3.1/100 py (95%CI 2.2-4.2) and 0.8/100 py (95%CI 0.5-1.4). Only 23% of all cases of TB were microbiologically confirmed. Multivariate analyses showed that HAART reduced incident TB by approximately 70%, both for confirmed and all TB cases.
Conclusions:
In this high TB burden country, the incidence of diagnosis of TB in HIV-infected children is at least as high as that of adults. HAART reduces incident TB, but further prospective TB preventive and diagnostic studies are urgently needed in children.
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