HAART and risk of tuberculosis in HIV-infected South African children: a multi-site retrospective cohort
Abstract: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/mm3 (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.
Document Type: Regular Paper
Affiliations: 1: Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; and Johns Hopkins University Center for TB Research, Baltimore, Maryland, USA 2: Harriet Shezi HIV Clinic (Wits Paediatric HIV Clinics), Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa 3: Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa 4: Rehima Moosa Mother and Child Hospital (Wits Paediatric HIV Clinics), University of the Witwatersrand, Johannesburg, South Africa 5: KID-CRU, Tygerberg Children's Hospital and Stellenbosch University, Cape Town, South Africa 6: Johns Hopkins University Center for TB Research, Baltimore, Maryland, USA
Publication date: 2009-07-01
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