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。
