Tuberculosis in HIV-infected children in Europe, Thailand and Brazil: paediatric TB-HIV EuroCoord study
OBJECTIVE: To describe the incidence, presentation, treatment and treatment outcomes of tuberculosis (TB) in human immunodeficiency virus (HIV) infected children.
DESIGN: Observational study of TB diagnosed in HIV-infected children in 2011–2013.
RESULTS: Of 4265 children aged <16 years, 127 (3%) were diagnosed with TB: 6 (5%) in Western Europe, 80 (63%) in Eastern Europe, 27 (21%) in Thailand and 14 (11%) in Brazil, with estimated TB incidence rates of respectively 239, 982, 1633 and 2551 per 100 000 person-years (py). The majority (94%) had acquired HIV perinatally. The median age at TB diagnosis was 6.8 years (interquartile range 3.0–11.5). Over half (52%) had advanced/severe World Health Organization stage immunodeficiency; 67 (53%) were not on antiretroviral therapy (ART) at TB diagnosis. Preventive anti-tuberculosis treatment was given to 23% (n = 23) of 102 children diagnosed with HIV before TB. Eleven children had unfavourable TB outcomes: 4 died, 5 did not complete treatment, 1 had recurrent TB and 1 had an unknown outcome. In univariable analysis, previous diagnosis of acquired immune-deficiency syndrome, not being virologically suppressed on ART at TB diagnosis and region (Brazil) were significantly associated with unfavourable TB outcomes.
CONCLUSION: Most TB cases were from countries with high TB prevalence. The majority (91%) had favourable outcomes. Universal ART and TB prophylaxis may reduce missed opportunities for TB prevention.
Document Type: Research Article
Affiliations: 1: Medical Research Council Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials & Methodology, London, UK 2: Research Unit, Program for HIV Prevention and Treatment (Program for HIV Prevention and Treatment/Institut de Recherche pour le Développement Unités Mixtes Internationales 174), Chiang Mai, Thailand 3: Instituto de Infectologia Emilio Ribas, São Paolo, São Paolo, Brazil 4: Kyiv City Centre for Prevention and Control of AIDS, Kyiv, Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine 5: Kryvyi Rih City Centre for Prevention and Control of AIDS, Kryvyi Rih, Ukraine 6: Donetsk Regional Centre for Prevention and Control of AIDS, Donetsk, Ukraine 7: Irkutsk Regional Centre for Prevention and Control of AIDS and Infectious Diseases, Irkutsk, Ukraine 8: Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine 9: St Petersburg City Centre for Prevention and Control of AIDS and Infectious Diseases, St Petersburg, Russian Federation 10: Republican Clinical Hospital of Infectious Diseases, St Petersburg, Russian Federation 11: Marioupol City Centre for Prevention and Control of AIDS, Marioupol, Ukraine 12: Nakornping Hospital, Chiang Mai, Thailand; ***Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain 13: Riga East University Hospital, Latvian Centre of Infectious Diseases, Riga, Latvia 14: Perinatal Prevention of AIDS Initiative, Odessa, Ukraine 15: Institute of Child Health, UCL, London, UK
Publication date: 01 November 2016
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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