Department of Paediatrics, Makerere University, Kampala, Uganda.
Int J Tuberc Lung Dis. 2011 Aug;15(8):1082-6. doi: 10.5588/ijtld.10.0538.
To identify the incidence of tuberculosis (TB) in human immunodeficiency virus (HIV) infected children in a resource-limited setting before and after initiation of antiretroviral therapy (ART), and to assess the impact of TB screening by tuberculin skin testing and clinical history.
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.
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.
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.
在资源有限的环境中，在开始抗逆转录病毒治疗（ART）之前和之后，确定人类免疫缺陷病毒（HIV）感染儿童中的结核病（TB）发生率，并评估结核菌素皮肤试验和临床病史进行 TB 筛查的影响。
这是一项回顾性队列研究，纳入了 2003 年至 2006 年 7 月 1 日期间在乌干达坎帕拉开始接受 ART 的 1806 名 HIV 感染的儿童和青少年（年龄 <18 岁）。2006 年 1 月，在整个诊所范围内实施了 TB 筛查计划。
在 311 名（17.2%）HIV 感染儿童中，有 171 名在开始 ART 之前和 140 名在开始 ART 后被诊断患有 TB。在接受 ART 的前 100 天，新发 TB 诊断的风险比 ART 前时期高 2.7 倍（RR 2.7，95%CI 2.1-3.5，P < 0.001）。在接受 ART 100 天后，TB 发病率降至 ART 前水平以下（RR 0.41，95%CI 0.30-0.54，P = 0.002）。2006 年实施 TB 筛查后，开始 ART 后诊断的新发 TB 病例比例下降了 70%（95%CI 51-82，P < 0.001），从而减轻了早期的过度风险。
在撒哈拉以南非洲开始接受 ART 的非洲儿童和青少年中，TB 很常见。在开始 ART 之前更积极地筛查活动性 TB，可以降低免疫重建期间的 TB 发生率。需要进一步的研究来确定 HIV 感染儿童的最佳筛查方法。
