Almost 1 in 5 HIV-positive children in a 13-year Asian observational study had pulmonary tuberculosis. More than one third of pulmonary TB cases developed after antiretroviral therapy (ART) had begun.
TB remains a serious threat to HIV-positive people with a compromised immune system and living in regions with high TB prevalence. To determine prevalence, characteristics, and treatment outcomes of pulmonary TB in HIV-positive Asian children, researchers conducted a retrospective analysis of children in the TREAT Asia Pediatric HIV Observational Database (TApHOD).
The TApHOD team extracted data on children from the 12 months before they started ART to 31 December 2009. The analysis included 2678 children in TApHOD over a 13-year period. During that time, pulmonary TB developed in 457 children to yield a period prevalence of 17.1% (range 5.7% to 33.0% per country). Twenty-seven children had 2 episodes of pulmonary TB, and 21 children (4.6%) died.
Of the 484 pulmonary TB episodes, 175 (36%) developed a median of 14.1 months after ART began. Median CD4 percent and count at TB diagnosis were 9.0% (interquartile range [IQR] 3.0% to 16.0%) and 183.5 cells/µL (IQR 37.8 to 525.0).
Almost all pulmonary TB episodes (424 of 436, 97.3%) had abnormal radiographic findings compatible with pulmonary TB, while 267 of 484 cases (55.2%) had clinical characteristics of pulmonary TB. Among 122 children tested for bacteriologic evidence of pulmonary TB, 42 (34.4%) had such evidence. Among 156 cases (32.2%) with extrapulmonary manifestations, pleuritis was the most common, in 81.4%.
Among the 484 pulmonary TB cases, 396 (81.8%) had a positive outcome (cured, treatment completed and child well, or improvement).
The researchers conclude that “children with persistent immunosuppression remain vulnerable to pulmonary TB even after ART initiation.”
Source: Tavitiya Sudjaritruk, Alan Maleesatharn, Wasana Prasitsuebsai, Siew Moy Fong, Oanh LeNgoc, Thuy Thi Le Thanh, Pagakrong Lumbiganon, Nagalingeswaran Kumarasamy, Nia Kurniati, Rawiwan Hansudewechakul, Nik Yusoff, Nik Khairulddin, Kamarul Razali, Mohd Azahar, Azar Kariminia, Annette H. Sohn, Virat Sirisanthana, on behalf of the TREAT Asia Pediatric HIV Observational Database. AIDS Patient Care and STDs. Prevalence, characteristics, management, and outcome of pulmonary tuberculosis in HIV-infected children in the TREAT Asia Pediatric HIV Observational Database (TApHOD). AIDS Patient Care and STDs. 2013; 27: 649-656.
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