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Tuberculosis and HIV Coinfection Admissions and Outcome in Children at a Nigerian Tertiary Hospital
Olusola Adetunji Oyedeji1, Funso Abidemi Olagunju1, Abimbola Ololade Odeyemi1
1Department of Paediatrics and Child Health, Osun State University Teaching Hospital, Osogbo, Osun State, Nigeria.
Insights
Tuberculosis and HIV coinfection in children often leads to poor outcomes, especially with standard treatment. Category 1 Anti-Tb therapy is not recommended for immunocompromised children with HIV and tuberculosis coinfection.
Area of Science:
- Pediatric Infectious Diseases
- Global Health
- Immunology
Background:
- Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are major causes of illness and death in children in developing nations.
- Factors influencing morbidity in children with TB-HIV coinfection require further investigation.
Purpose of the Study:
- To investigate the clinical presentation and outcomes of TB in children with HIV.
- To identify factors associated with treatment success in these coinfected children.
Main Methods:
- A cohort of children diagnosed with both TB and HIV coinfection was studied.
- Data on presentation, management, and outcomes were collected and analyzed.
Main Results:
- Thirty-six children (mean age 6.7 years) with TB-HIV coinfection were analyzed.
- Pulmonary TB was most common (63.9%), followed by disseminated (16.7%) and abdominal TB (11.1%).
- Treatment failure with Category 1 Anti-TB drugs occurred in 33.3% of children, significantly associated with immunosuppression (CD4 <200), high viral load (>1000 copies/mL), disseminated disease, and AIDS (P < 0.01).
- Mortality was 16.7% (6 deaths).
Conclusions:
- Category 1 (Short course) Anti-TB therapy is not suitable for HIV-TB coinfected children with severe immunosuppression, unsuppressed viral loads, disseminated TB, or AIDS.
- Treatment strategies must be individualized based on immune status and disease presentation.
Background:
Tuberculosis and HIV are significant contributors to morbidity and mortality in children living in developing countries. Factors associated with morbidity in tuberculosis and HIV coinfections have not been sufficiently exhaustively studied.
Aim:
The aim of this study was to study the pattern of presentation and outcome of tuberculosis in HIV infected children and identify factors associated with outcome of management.
Methodology:
Consecutive children diagnosed with tuberculosis and HIV coinfections at the pediatric unit of UNIOSUN teaching hospitals were studied. Necessary data were obtained and analyzed.
Results:
A total of 36 children with HIV and tuberculosis coinfection were studied, with age ranging from 3 months to 17 years (mean 6.7 ± 4.3 years). The 36 children consisted of 21 boys (58.3%) boys and 15 (53.6%) girls. The forms of tuberculosis diagnosed were pulmonary 23 (63.9%). Disseminated and abdominal tuberculosis were diagnosed in 6 (16.7%) and 4 (11.1%) children, respectively. Miliary, meningeal forms of tuberculosis with tuberculoma were diagnosed in 1 (2.7%) child each. Twelve (33.3%) children exhibited treatment failure to Category I antituberculous (Anti-Tb) drugs. The majority 8 (66.7%) of the 12 with Category 1 treatment failure had underlying AIDS. Category I Anti-Tb therapy treatment failure was significantly associated with immunological suppression, (CD4 <200 cells/μl, poor viral load suppression (viral load >1000copies/mL, disseminated disease and AIDS ( P < 0.01). Six deaths (16.7%) were recorded in the course of the study, whereas 30 (83.3%) survived.
Conclusion:
Pediatric tuberculosis HIV coinfection should not be managed with Category 1 (Short course) Anti-Tb therapy in HIV tuberculosis coinfected children with associated immunosuppression or unsuppressed viral loads or with disseminated tuberculosis or AIDS.
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