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Free Content Bacteriologically confirmed tuberculosis in HIV-infected infants: disease spectrum and survival

BACKGROUND: The human immunodeficiency virus (HIV) has resulted in epidemiological shifts with an emergence of tuberculosis (TB) amongst HIV-infected women and infants. There are limited data on the TB disease spectrum and outcome amongst HIV-infected infants.

OBJECTIVES: We describe the clinical characteristics, treatment and survival of HIV-infected infants with culture-confirmed TB.

METHODS: This retrospective hospital-based study from Cape Town, South Africa, used routine laboratory-based surveillance among infants diagnosed with culture-confirmed TB from 1 January 2004 to 31 December 2006. Folder and chest radiographic review were completed and vitality status established. TB was classified as pulmonary, extra-pulmonary or disseminated disease.

RESULTS: Of 52 infants, 37 (71.1%) had pulmonary, 2 (3.9%) extra-pulmonary only, 7 (13.5%) pulmonary and extra-pulmonary and 6 (11.5%) disseminated TB. Forty-six (88.5%) were started anti-tuberculosis therapy; 37 (71.2%) received antiretroviral therapy (ART) and 17 (32.7%) died, 10 (19.2%) of whom never started ART. HIV stage 4 disease was associated with death. TB treatment outcome was poorly documented.

CONCLUSIONS: TB is associated with advanced HIV disease and high mortality in HIV-infected infants. Missed opportunities for initiation of ART were frequent. Although the effects of young age, TB disease spectrum and HIV co-infection are difficult to distinguish, our findings support the initiation of early ART in HIV-infected infants with TB.

Keywords: HIV; TB; disease spectrum; infants; mortality

Document Type: Regular Paper

Affiliations: 1: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa 2: KidCru, Tygerberg Academic Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa 3: Department of Medical Microbiology, University of Cape Town, Cape Town, South Africa; and National Health Laboratory Service, Cape Town, South Africa 4: G25 Paediatric HIV/AIDS Services, Groote Schuur Hospital, Cape Town, South Africa

Publication date: June 1, 2011

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