Walters Elisabetta, Cotton Mark F, Rabie Helena, Schaaf H Simon, Walters Lourens O, Marais Ben J
Department of Pediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
BMC Pediatr. 2008 Jan 11;8:1. doi: 10.1186/1471-2431-8-1.
The tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics are poorly controlled in sub-Saharan Africa, where highly active antiretroviral treatment (HAART) has become more freely available. Little is known about the clinical presentation and outcome of TB in HIV-infected children on HAART.
We performed a comprehensive file review of all children who commenced HAART at Tygerberg Children's Hospital from January 2003 through December 2005.
Data from 290 children were analyzed; 137 TB episodes were recorded in 136 children; 116 episodes occurred before and 21 after HAART initiation; 10 episodes were probably related to immune reconstitution inflammatory syndrome (IRIS). The number of TB cases per 100 patient years were 53.3 during the 9 months prior to HAART initiation, and 6.4 during post HAART follow-up [odds ratio (OR) 16.6; 95% confidence interval (CI) 12.5-22.4]. A positive outcome was achieved in 97/137 (71%) episodes, 6 (4%) cases experienced no improvement, 16 (12%) died and the outcome could not be established in 18 (13%). Mortality was less in children on HAART (1/21; 4.8%) compared to those not on HAART (15/116; 12.9%).
We recorded an extremely high incidence of TB among HIV-infected children, especially prior to HAART initiation. Starting HAART at an earlier stage is likely to reduce morbidity and mortality related to TB, particularly in TB-endemic areas. Management frequently deviated from standard guidelines, but outcomes in general were good.
在撒哈拉以南非洲地区,结核病(TB)和人类免疫缺陷病毒(HIV)疫情控制不佳,而高效抗逆转录病毒治疗(HAART)在此地区已更广泛可得。对于接受HAART治疗的HIV感染儿童中结核病的临床表现及转归知之甚少。
我们对2003年1月至2005年12月在泰格堡儿童医院开始接受HAART治疗的所有儿童进行了全面的病历回顾。
分析了290名儿童的数据;136名儿童记录有137次结核病发作;116次发作发生在开始HAART之前,21次发生在开始HAART之后;10次发作可能与免疫重建炎症综合征(IRIS)有关。在开始HAART前的9个月中,每100患者年的结核病病例数为53.3,在HAART治疗后的随访期间为6.4 [优势比(OR)16.6;95%置信区间(CI)12.5 - 22.4]。137次发作中有97次(71%)获得了良好转归,6例(4%)病情无改善,16例(12%)死亡,18例(13%)的转归情况无法确定。接受HAART治疗的儿童死亡率(1/21;4.8%)低于未接受HAART治疗的儿童(15/116;12.9%)。
我们记录到HIV感染儿童中结核病发病率极高,尤其是在开始HAART之前。在更早阶段开始HAART可能会降低与结核病相关的发病率和死亡率,特别是在结核病流行地区。治疗管理常偏离标准指南,但总体转归良好。