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: November 1, 2016
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