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Tuberculosis in human immunodeficiency virus-exposed or -infected United States children
1Department of Pediatrics, Duke University Medical Center, Durham, NC 27710.
Insights
Children with HIV exposure or infection have significantly higher rates of tuberculosis disease and drug-resistant infections. This study highlights the urgent need for improved diagnostics and treatment strategies for this vulnerable population.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Research
- Tuberculosis Epidemiology
Background:
- Infants and children with human immunodeficiency virus (HIV) exposure or infection are at increased risk for tuberculosis (TB).
- Limited data exist on the burden of TB disease, infection, and drug resistance in this pediatric population within the United States.
Purpose of the Study:
- To assess the occurrence of TB exposure, infection, and disease in a national sample of HIV-exposed or infected children.
- To determine the prevalence of multidrug-resistant Mycobacterium tuberculosis isolates (resistant to isoniazid and rifampin) in these children and their adult contacts.
Main Methods:
- A retrospective questionnaire survey was conducted across 70 pediatric HIV referral centers in the United States.
- Data were collected from 14,038 pediatric patients evaluated by the Pediatric Acquired Immunodeficiency Syndrome Clinical Trials Group (PACTG).
Main Results:
- A total of 75 cases of TB disease were reported, with annualized case rates significantly higher in recent years (478/100,000 for 1990-1992) compared to earlier periods.
- TB case rates in this cohort were substantially higher than the general US pediatric population (5.5/100,000 in 1992).
- Twenty percent of isolates from PACTG patients and 15% from adult contacts exhibited resistance to both isoniazid and rifampin.
Conclusions:
- HIV-exposed or infected children in the US experience disproportionately high rates of TB disease.
- A significant prevalence of multidrug-resistant TB was observed in this vulnerable pediatric population and their contacts.
- Findings underscore the critical need for enhanced TB surveillance, prevention, and treatment strategies for children living with or exposed to HIV.
Abstract:
This study was designed to provide a preliminary assessment of the occurrence of tuberculosis exposure, infection and disease within a national sample of infants and children with human immunodeficiency virus (HIV) exposure or infection, and to determine the prevalence of Mycobacterium tuberculosis isolates resistant both to isoniazid and rifampin in these patients or their adult source contacts. A retrospective questionnaire survey was conducted of infants and children with HIV exposure or infection evaluated by pediatric HIV referral centers in the United States comprising the pediatric units or subunits of the Pediatric Acquired Immunodeficiency Syndrome Clinical Trials Group (PACTG). Seventy of 72 sites during a mean period of 5 (range, 1 to 12) years participated in this study and had provided care for 14,038 patients. There were 75 cumulative total cases of tuberculosis disease seen since each site was established. Therapy for asymptomatic infection was given to another 40 children and for tuberculosis exposure to 71 children. Annualized case rates were 478/100,000 for sites established in 1990 to 1992, 117/100,000 for 1988 to 1989, 63/100,000 for 1986 to 1987 and 58/100,000 for 1981 to 1985 (P = 0.05, Spearman's p test for trend). By comparison, the 1992 age-specific tuberculosis case rate for all U.S. children < 5 years was 5.5/100,000. Twenty percent of isolates from PACTG patients and 15% of isolates from adult source contacts were resistant to isoniazid and rifampin.(ABSTRACT TRUNCATED AT 250 WORDS)