13th Conference on Retroviruses and Opportunistic Infections Denver, Colorado - February 5-8, 2006

Conf Retrovir Opportunistic Infect 2006 Feb 5-8;13:abstract no. 22

Neil Martinson^1,2, H Moultrieh¹, G Barry¹, A Violari¹, M Cotton³, R Van Niekerk¹, L Kalete¹, A Coovadia¹, T Meyers¹, and G Gray^1
1Univ of the Witwatersrand, Johannesburg, South Africa; ²Johns Hopkins Univ Ctr for Tuberculosis Res, Baltimore, MD, US; and ³Tygerberg Hosp, Stellenbosch Univ, Cape Town, South Africa

BACKGROUND: In developing settings, tuberculosis (TB) is a leading opportunistic infection and a common cause of death in HIV-infected children. Adult cohort studies report 50 to 80% reductions in TB incidence with HAART therapy. However, longitudinal data in HIV-infected children is scarce. Diagnostic difficulties compound the problem. We compare the incidence of a diagnosis of TB and the incidence of confirmed TB in HAART treated and untreated children at 4 South African ART clinics: 3 in Johannesburg and 1 in Cape Town.

METHODS: Records were reviewed retrospectively. Children <15 years were eligible if clinic visits were recorded at least twice every 6 months. Follow-up time started when the first CD4 percentage was recorded and stopped at the last clinic visit. Records were scrutinized for a TB diagnosis. The basis for the diagnosis, date(s) and duration of treatment were abstracted. Children were temporarily censored while on TB treatment. If ART were prescribed, the date of initiation and duration of treatment was recorded.

RESULTS: We reviewed 950 records. At the start of follow-up, median age, CD4%, and viral load of all children was 6.7 years, 16.4%, and 44,418 copies/mL. The male:female ratio was 1:1. Median follow up time of all children was 1.8 years. Two thirds of the cohort received HAART for more than 3 months. The incidence of TB while receiving HAART was 8.3/100 person-years (95%CI 6.3 to 10.9) despite being more immunocompromised. In those not receiving HAART, the incidence was 14.4/100 person-years (95%CI 12.5 to 16.6). One fifth of all diagnoses of TB were made with bacteriological or biopsy confirmation. The incidence of confirmed TB in the entire cohort was 3.2/100 person-years (95%CI 2.0 to 4.9) in HAART-treated children and 2.5/100 person-years (95%CI 1.8 to 3.7) in untreated children. In a sub-group of children whose follow-up included time in both HAART exposures, the incidence of TB in HAART-treated and untreated time was 8.4/100 person-years (95%CI 5.7 to 10.2) and 17.9/100 person-years (95%CI 15.2 to 20.9), respectively, and for bacteriological or biopsy confirmed TB was 3.1 per 100 person-years (95%CI 1.9 to 4.8) and 2.9/100 person-years (95%CI 1.9 to 4.3), respectively.

CONCLUSIONS: Incidence of TB in HIV-infected children is high but few cases are confirmed. Overall, HAART protects HIV-infected children from TB but to a lesser extent than in adults. In this preliminary analysis, HAART was not protective for bacteriologically or biopsy confirmed TB. Prospective studies should confirm our findings.

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2006-02-05
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