Tuberculosis in human immunodeficiency virus infected Ugandan children starting on antiretroviral therapy
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.
Keywords: AIDS; HIV; antiretroviral therapy; children; tuberculosis
Document Type: Regular Paper
Affiliations: 1: Department of Paediatrics, College of Health Science, Makerere University, Kampala, Uganda; Paediatric Infectious Diseases Clinic, Baylor-Uganda, Mulago, Uganda; Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA 2: Institute of Tropical Medicine and University of Antwerp, Antwerp, Belgium 3: Paediatric Infectious Diseases Clinic, Baylor-Uganda, Mulago, Uganda 4: Paediatric Infectious Diseases Clinic, Baylor-Uganda, Mulago, Uganda; Baylor College of Medicine, Houston, Texas, USA 5: Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA; Baylor College of Medicine, Houston, Texas, USA; Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
Publication date: 01 August 2011
The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.
The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.
- Editorial Board
- Information for Authors
- Subscribe to this Title
- International Journal of Tuberculosis and Lung Disease
- Public Health Action
- Ingenta Connect is not responsible for the content or availability of external websites
Receive new issue alert- Access Key
- Free content
- Partial Free content
- New content
- Open access content
- Partial Open access content
- Subscribed content
- Partial Subscribed content
- Free trial content