Microbiological investigation for tuberculosis among HIV-infected children in Soweto, South Africa

• Published in: The international journal of tuberculosis and lung disease Vol. 18; no. 6; pp. 676 - 681
• Main Authors: Fairlie, L., Muchiri, E., Beylis, C. N., Meyers, T., Moultrie, H.
• Format: Journal Article
• Language: English
• Published: Paris International Union Against Tuberculosis and Lung Disease 01.06.2014; International Union against Tuberculosis and Lung Disease
• Subjects: Academic Medical Centers; Adolescent; Age Factors; Antitubercular Agents - therapeutic use; Bacterial diseases; Bacteriological Techniques; Biological and medical sciences; Chi-Square Distribution; Child; Child, Preschool; Coinfection; Cross-Sectional Studies; Drug Therapy, Combination; Female; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - immunology; HIV Infections - virology; Human bacterial diseases; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infant; Infectious diseases; Logistic Models; Male; Medical sciences; Microbial Sensitivity Tests; Microbiological Tb Investigations; Multivariate Analysis; Mycobacterium; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - immunology; Mycobacterium tuberculosis - isolation & purification; Odds Ratio; Outpatient Clinics, Hospital; paediatric TB-HIV; Pneumology; Predictive Value of Tests; Retrospective Studies; Risk Factors; South Africa - epidemiology; Time Factors; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - immunology; Tuberculosis - microbiology; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Multidrug-Resistant - diagnosis; Tuberculosis, Multidrug-Resistant - microbiology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; South Africa; Africa; Human; Immunopathology; Pediatrics; Respiratory disease; Retroviridae; AIDS; Mycobacterial infection; microbiological TB investigations; Immune deficiency; Lentivirus; Infection; Virus; Microbiological investigation; Tuberculosis; Viral disease; Bacteriosis; Human immunodeficiency virus; Child; paediatric TB-HIV
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.13.0839

SETTING:A paediatric human immunodeficiency virus (HIV) clinic in an academic hospital in Soweto, South Africa. OBJECTIVES:1) To describe and compare the clinical, immunological and virological characteristics of HIV-infected children co-treated for tuberculosis (TB), and 2) to compare those investigated microbiologically with those who were not, with a description of the results of the microbiological TB investigation. DESIGN:Retrospective analysis of TB-HIV-infected children aged <15 years treated for TB between 1 October 2007 and 15 March 2009. RESULTS:Anti-tuberculosis treatment was initiated in 616/3358 (18%) children during the study period. Microbiological TB investigation results were available for 399/616 (65%), among whom culture-confirmed TB was diagnosed in 49 (12%). Drug susceptibility testing was performed in 29/49 (59%) children: 5/29 (17%) were isoniazid-resistant, and 3 had multidrug-resistant TB. Children aged >8 years and those between 3 and 8 years were more likely to have culture-confirmed TB than those aged <3 years (aOR 9.4, 95%CI 2.26-39.08 vs. aOR 6.7, 95%CI 1.60-27.69), as were those with CD4 count <200 cells/mm3 compared to those with >500 cells/mm3 (aOR 3.95, 95%CI 1.23-12.72). CONCLUSION:Our study in HIV-infected children showed a high TB case rate, a low rate of definite TB and a high rate of drug-resistant TB based on World Health Organization case definitions. Increased uptake of available TB tests and availability of new diagnostic tests remains a priority in high TB-HIV burden settings.