Free Content HAART and risk of tuberculosis in HIV-infected South African children: a multi-site retrospective cohort

 Download
(PDF 263.8 kb)
 
Download Article:

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.

Keywords: HAART; HIV; cohort; paediatric; tuberculosis

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: July 1, 2009

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

  • Editorial Board
  • Information for Authors
  • Subscribe to this Title
  • International Journal of Tuberculosis and Lung Disease
  • Public Health Action
  • ingentaconnect is not responsible for the content or availability of external websites
Related content

Tools

Favourites

Share Content

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
ingentaconnect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more