Hesseling A C, Cotton M F, Jennings T, Whitelaw A, Johnson L F, Eley B, Roux P, Godfrey-Faussett P, Schaaf H S
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, South Africa.
Clin Infect Dis. 2009 Jan 1;48(1):108-14. doi: 10.1086/595012.
There are limited population-based estimates of tuberculosis incidence among human immunodeficiency virus (HIV)-infected and HIV-uninfected infants aged < or =12 months. We aimed to estimate the population-based incidence of culture-confirmed tuberculosis among HIV-infected and HIV-uninfected infants in the Western Cape Province, South Africa.
The incidences of pulmonary, extrapulmonary, and disseminated tuberculosis were estimated over a 3-year period (2004-2006) with use of prospective representative hospital surveillance data of the annual number of culture-confirmed tuberculosis cases among infants. The total number of HIV-infected and HIV-uninfected infants was calculated using population-based estimates of the total number of live infants and the annual maternal HIV prevalence and vertical HIV transmission rates.
There were 245 infants with culture-confirmed tuberculosis. The overall incidences of tuberculosis were 1596 cases per 100,000 population among HIV-infected infants (95% confidence interval [CI], 1151-2132 cases per 100,000 population) and 65.9 cases per 100,000 population among HIV-uninfected infants (95% CI, 56-75 cases per 100,000 population). The relative risk of culture-confirmed tuberculosis among HIV-infected infants was 24.2 (95% CI, 17-34). The incidences of disseminated tuberculosis were 240.9 cases per 100,000 population (95% CI, 89-433 cases per 100,000 population) among HIV-infected infants and 14.1 cases per 100,000 population (95% CI, 10-18 cases per 100,000 population) among HIV-uninfected infants (relative risk, 17.1; 95% CI, 6-34).
This study indicates the magnitude of the tuberculosis disease burden among HIV-infected infants and provides population-based comparative incidence rates of tuberculosis among HIV-infected infants. This high risk of tuberculosis among HIV-infected infants is of great concern and may be attributable to an increased risk of tuberculosis exposure, increased immune-mediated tuberculosis susceptibility, and/or possible limited protective effect of bacille Calmette-Guérin vaccination. Improved tuberculosis control strategies, including maternal tuberculosis screening, contact tracing of tuberculosis-exposed infants coupled with preventive chemotherapy, and effective vaccine strategies, are needed for infants in settings where HIV infection and tuberculosis are highly endemic.
关于12个月及以下感染人类免疫缺陷病毒（HIV）和未感染HIV的婴儿中结核病发病率的基于人群的估计数据有限。我们旨在估计南非西开普省感染HIV和未感染HIV的婴儿中经培养确诊的结核病的人群发病率。
利用前瞻性代表性医院监测数据，对3年期间（2004 - 2006年）婴儿中经培养确诊的结核病病例数进行估计，以得出肺、肺外和播散性结核病的发病率。通过基于人群的活产婴儿总数估计数以及年度孕产妇HIV流行率和HIV垂直传播率，计算出感染HIV和未感染HIV的婴儿总数。
有245名婴儿经培养确诊患有结核病。感染HIV的婴儿中结核病的总体发病率为每10万人1596例（95%置信区间[CI]，每10万人1151 - 2132例），未感染HIV的婴儿中为每10万人65.9例（95% CI，每10万人56 - 75例）。感染HIV的婴儿中经培养确诊的结核病的相对风险为24.2（95% CI，17 - 34）。感染HIV的婴儿中播散性结核病的发病率为每10万人240.9例（95% CI，每10万人89 - 433例），未感染HIV的婴儿中为每10万人14.1例（95% CI，每10万人10 - 18例）（相对风险，17.1；95% CI，6 - 34）。
本研究表明了感染HIV的婴儿中结核病疾病负担的程度，并提供了基于人群的感染HIV的婴儿中结核病的比较发病率。感染HIV的婴儿中结核病的这种高风险令人高度担忧，可能归因于结核病暴露风险增加、免疫介导的结核病易感性增加和/或卡介苗接种的保护作用可能有限。在HIV感染和结核病高度流行的地区，需要改进结核病控制策略，包括孕产妇结核病筛查、对接触结核病的婴儿进行接触者追踪并辅以预防性化疗，以及有效的疫苗策略。
