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Tuberculosis in human immunodeficiency virus-infected children. A family infection
S S Bakshi1, D Alvarez, C L Hilfer
1Department of Pediatrics, Columbia University College of Physicians and Surgeons, St Luke's Roosevelt Hospital Center, New York, NY.
Insights
Tuberculosis is a significant concern for children with human immunodeficiency virus (HIV). HIV-infected children experienced severe tuberculosis, often linked to parental drug use and non-adherence to treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Human immunodeficiency virus (HIV) infection increases susceptibility to opportunistic infections.
- Tuberculosis (TB) remains a major global health challenge, particularly in vulnerable populations.
- Co-infection with HIV and TB presents complex clinical management issues.
Purpose of the Study:
- To investigate the epidemiological and clinical characteristics of Mycobacterium tuberculosis infection.
- To assess TB prevalence and risk factors in children with HIV and their families.
- To understand the clinical presentation and outcomes of TB in HIV-infected children.
Main Methods:
- Prospective follow-up of 60 families with children diagnosed with HIV, indeterminate HIV status, or seroreversion.
- Diagnosis of Mycobacterium tuberculosis infection based on positive Mantoux test or culture.
- Clinical data collection on exposure, symptoms, and treatment outcomes.
Main Results:
- Tuberculosis was diagnosed in 6% of children across four families.
- Six of seven infected children had exposure to an adult with TB, often associated with HIV, drug use, homelessness, or non-adherence.
- HIV-infected children and one seroreverter developed pulmonary tuberculosis; one child died from complications.
Conclusions:
- Tuberculosis poses an increasing threat to children born to HIV-infected parents in inner-city settings.
- HIV-infected children exhibit severe, symptomatic tuberculosis mirroring local drug resistance patterns.
- Early detection and management of TB in HIV-infected families are crucial.
Objective:
To study the epidemiologic and clinical features of infection with Mycobacterium tuberculosis in human immunodeficiency virus (HIV)-infected children and their families. PATIENTS AND CLINICAL SETTING: Sixty families of children with HIV infection, children of HIV indeterminate status, and seroreverters underwent follow-up in a comprehensive multidisciplinary program for children and families.
Methods:
Infection with M tuberculosis was diagnosed based on a positive Mantoux test result or a positive culture.
Results:
Mycobacterium tuberculosis infection was diagnosed in seven children (three infected with HIV, three seroreverters, and one uninfected sibling of an infected child) from four families (6%). All infections were detected in the period from March 1990 through January 1992. Six of seven children had a history of exposure to M tuberculosis in an HIV-infected adult (parent) who was an intravenous drug user, homeless, and/or noncompliant with the medical regimen. All HIV-infected children and one seroreverter had pulmonary tuberculosis. One child died of complications of tuberculosis and HIV infection. The M tuberculosis isolated from this child was resistant to isoniazid, rifampin, and streptomycin sulfate.
Conclusions:
Tuberculosis is a growing problem among inner-city children born to HIV-infected parents. Children infected with HIV in this study had symptomatic and severe disease with tuberculosis, which reflected the drug susceptibility pattern of M tuberculosis seen in our community.