Tuberculosis in human immunodeficiency virus infected Ugandan children starting on antiretroviral therapy
Abstract:OBJECTIVE: To identify the incidence of tuberculosis (TB) in human immunodeficiency virus (HIV) infected children in a resource-limited setting before and after initiation of antiretroviral therapy (ART), and to assess the impact of TB screening by tuberculin skin testing and clinical history.
METHODS: A retrospective cohort study of 1806 HIV-infected children and adolescents (age <18 years) initiating ART from 2003 to 1 July 2006 in Kampala, Uganda. A TB screening program was instituted clinic-wide in January 2006.
RESULTS: Of 311 (17.2%) HIV-infected children, 171 had been diagnosed with TB before and 140 after ART initiation. During the first 100 days of ART, risk of a new TB diagnosis was 2.7-fold higher compared to the pre-ART period (RR 2.7, 95%CI 2.1–3.5, P < 0.001). After 100 days of ART, the TB incidence rate decreased to below pre-ART levels (RR 0.41, 95%CI 0.30–0.54, P = 0.002). After TB screening was instituted in 2006, the proportion of new TB cases diagnosed after starting ART decreased by 70% (95%CI 51–82, P < 0.001), abating the early excess risk.
CONCLUSIONS: TB is common among African children and adolescents initiating ART in sub-Saharan Africa. More aggressive screening for active TB before starting ART can diminish the rate of TB during immune reconstitution. Future studies are needed to determine optimal screening practices for HIV-infected children.
Document Type: Regular Paper
Affiliations: 1: Department of Paediatrics, College of Health Science, Makerere University, Kampala, Uganda; Paediatric Infectious Diseases Clinic, Baylor-Uganda, Mulago, Uganda; Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA 2: Institute of Tropical Medicine and University of Antwerp, Antwerp, Belgium 3: Paediatric Infectious Diseases Clinic, Baylor-Uganda, Mulago, Uganda 4: Paediatric Infectious Diseases Clinic, Baylor-Uganda, Mulago, Uganda; Baylor College of Medicine, Houston, Texas, USA 5: Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA; Baylor College of Medicine, Houston, Texas, USA; Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
Publication date: 2011-08-01
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.
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