IngentaConnect HAART and risk of tuberculosis in HIV-infected South African chil...

Authors: Martinson, N.A.¹; Moultrie, H.²; van Niekerk, R.³; Barry, G.⁴; Coovadia, A.⁴; Cotton, M.⁵; Violari, A.³; Gray, G.E.³; Chaisson, R.E.⁶; McIntyre, J.A.³; Meyers, T.²

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 7, July 2009 , pp. 862-867(6)

Publisher: International Union Against Tuberculosis and Lung Disease

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: paediatric; HIV; tuberculosis; HAART; cohort

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

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