Tuberculosis in human immunodeficiency virus infected Ugandan children starting on antiretroviral therapy

S Bakeera-Kitaka, A Conesa-Botella, A Dhabangi, A Maganda, A Kekitiinwa, R Colebunders, DR Boulware

    Research output: Contribution to journalA1: Web of Science-article

    Abstract

    OBJECTIVE: To identify the incidence of tuberculosis (TB) in human immunodeficiency virus (HIV) infected children in a resource-limited setting before and after initiation of antiretroviral therapy (ART), and to assess the impact of TB screening by tuberculin skin testing and clinical history. METHODS: A retrospective cohort study of 1806 HIV-infected children and adolescents (age <18 years) initiating ART from 2003 to 1 July 2006 in Kampala, Uganda. A TB screening program was instituted clinic-wide in January 2006. RESULTS: Of 311 (17.2%) HIV-infected children, 171 had been diagnosed with TB before and 140 after ART initiation. During the first 100 days of ART, risk of a new TB diagnosis was 2.7-fold higher compared to the pre-ART period (RR 2.7, 95%CI 2.1-3.5, P < 0.001). After 100 days of ART, the TB incidence rate decreased to below pre-ART levels (RR 0.41, 95%CI 0.30-0.54, P = 0.002). After TB screening was instituted in 2006, the proportion of new TB cases diagnosed after starting ART decreased by 70% (95%CI 51-82, P < 0.001), abating the early excess risk. CONCLUSIONS: TB is common among African children and adolescents initiating ART in sub-Saharan Africa. More aggressive screening for active TB before starting ART can diminish the rate of TB during immune reconstitution. Future studies are needed to determine optimal screening practices for HIV-infected children.
    Original languageEnglish
    JournalInternational Journal of Tuberculosis and Lung Disease
    Volume15
    Issue number8
    Pages (from-to)1082-1086
    Number of pages5
    ISSN1027-3719
    DOIs
    Publication statusPublished - 2011

    Keywords

    • B780-tropical-medicine
    • Viral diseases
    • HIV
    • AIDS
    • Co-infections
    • Bacterial diseases
    • Tuberculosis
    • Mycobacterium tuberculosis
    • Incidence
    • HAART
    • Antiretrovirals
    • Children
    • Impact assessment
    • Screening
    • Tuberculin testing
    • Control programs
    • Classification
    • Severity
    • Uganda
    • Africa-East

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