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Tuberculosis in HIV-infected South African children with complicated severe acute malnutrition
H Adler1, M Archary2, P Mahabeer3
1Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland, Paediatric Infectious Diseases Unit, King Edward VIII Hospital, University of KwaZulu Natal, Durban, South Africa, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Insights
Tuberculosis (TB) is common in children with HIV and severe acute malnutrition (SAM). Sputum sampling aids TB diagnosis, but empiric treatment is frequent due to diagnostic challenges.
Area of Science:
- Pediatric Infectious Diseases
- Global Health
- Clinical Microbiology
Background:
- Tuberculosis (TB) poses a significant threat to children co-infected with human immunodeficiency virus (HIV) and presenting with severe acute malnutrition (SAM).
- Diagnostic challenges in this vulnerable population often lead to delayed or missed TB diagnoses, complicating treatment and outcomes.
- Effective management requires understanding the incidence and specific diagnostic hurdles in HIV-infected children with SAM.
Purpose of the Study:
- To determine the incidence of TB in HIV-infected children with SAM.
- To identify diagnostic challenges associated with TB detection in this cohort.
- To explore factors influencing TB diagnosis in HIV-infected children with SAM.
Main Methods:
- A post-hoc analysis was conducted on data from a randomized controlled trial involving antiretroviral therapy-naïve, HIV-infected children with SAM.
- Clinical diagnoses and microbiological confirmation of TB were extracted from trial records and laboratory results.
- Negative binomial regression was employed to analyze associations with confirmed TB cases, excluding those without microbiological support.
Main Results:
- Out of 82 children, 21 (25.6%) were diagnosed with TB, with 8 cases bacteriologically confirmed.
- Sputum sampling demonstrated an increased likelihood of TB diagnosis compared to gastric washings (aRR 1.134).
- Culture-proven bacterial infection during admission was linked to a reduced risk of TB diagnosis (aRR 0.856), potentially due to empiric antibiotic use.
Conclusions:
- Tuberculosis is highly prevalent in HIV-infected children experiencing SAM.
- Despite feasible microbiological confirmation, empiric TB treatment is common, influenced by suboptimal testing and false-negative results.
- Integrating rigorous microbiological TB investigations is crucial for managing HIV and SAM programs effectively.
Setting:
Academic tertiary referral hospital in Durban, South Africa.
Objective:
To describe the incidence and diagnostic challenges of tuberculosis (TB) in human immunodeficiency virus (HIV) infected children with severe acute malnutrition (SAM).
Design:
Post-hoc analysis of a randomised controlled trial that enrolled antiretroviral therapy naïve, HIV-infected children with SAM. Trial records and hospital laboratory results were explored for clinical diagnoses and bacteriologically confirmed cases of TB. Negative binomial regression was used to explore associations with confirmed cases of TB, excluding cases where the clinical diagnosis was not supported by microbiological confirmation.
Results:
Of 82 children enrolled in the study, 21 (25.6%) were diagnosed with TB, with bacteriological confirmation in 8 cases. Sputum sampling (as opposed to gastric washings) was associated with an increased risk of subsequent diagnosis of TB (adjusted relative risk [aRR] 1.134, 95%CI 1.02-1.26). Culture-proven bacterial infection during admission was associated with a reduced risk of TB (aRR 0.856, 95%CI 0.748-0.979), which may reflect false-negative microbiological tests secondary to empiric broad-spectrum antibiotics.
Conclusion:
TB is common in HIV-infected children with SAM. While microbiological confirmation of the diagnosis is feasible, empiric treatment remains common, possibly influenced by suboptimal testing and false-negative TB diagnostics. Rigorous microbiological TB investigation should be integrated into the programmatic management of HIV and SAM.
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