Cranmer Lisa M, Kanyugo Mercy, Jonnalagadda Sasi R, Lohman-Payne Barbara, Sorensen Bess, Maleche Obimbo Elizabeth, Wamalwa Dalton, John-Stewart Grace C
From the *Department of Pediatrics, University of Washington; †Seattle Children's Hospital, Seattle, WA; ‡Department of Paediatrics, University of Nairobi, Nairobi, Kenya; §Department of Epidemiology; ¶Department of Medicine; and ‖Department of Global Health, University of Washington, Seattle, WA.
Pediatr Infect Dis J. 2014 Apr;33(4):401-6. doi: 10.1097/INF.0000000000000124.
Infants born to HIV-1 infected mothers may have increased risk for tuberculosis (TB), but the prevalence of TB infection in this population is undefined. In contrast to tuberculin skin tests that are confounded by recent bacille Calmette-Guérin (BCG) vaccination, TB interferon gamma release assays (IGRAs) do not cross-react with BCG and enable detection of TB infection in infancy.
In a nested observational cohort of HIV-1 infected Kenyan mothers and their infants, we conducted T-SPOT.TB assays on cryopreserved peripheral blood mononuclear cells from 6-month-old infants without prior active TB. Maternal and infant correlates of infant TB infection were assessed.
One hundred and eight-two infants were tested with T-SPOT.TB. Of 128 infants with determinate T-SPOT.TB results, the prevalence of a positive T-SPOT.TB was 10.9% [95% confidence interval (CI): 6.1-17.7%]. All infants were BCG-vaccinated and 7.0% were HIV-1 infected. Positive infant T-SPOT.TB was associated with maternal active TB (odds ratio: 15.5, 95% CI: 1.3-184; P = 0.04) and prolonged infant fever (>1 month) (odds ratio: 18.8, 95% CI: 1.6-223; P = 0.03).
We observed a high prevalence of TB infection in 6-month-old HIV-1 exposed infants. Improved TB detection and prevention are warranted in HIV-1 exposed infants at high risk for active TB disease.
感染人类免疫缺陷病毒1型（HIV-1）的母亲所生婴儿患结核病（TB）的风险可能增加，但该人群中结核感染的患病率尚不清楚。与因近期卡介苗（BCG）接种而混淆的结核菌素皮肤试验不同，结核干扰素γ释放试验（IGRAs）不会与卡介苗发生交叉反应，能够检测婴儿期的结核感染。
在一个对感染HIV-1的肯尼亚母亲及其婴儿进行嵌套观察的队列中，我们对6个月大且无活动性结核病病史的婴儿的冷冻保存外周血单个核细胞进行了T-SPOT.TB检测。评估了婴儿结核感染的母婴相关因素。
对182名婴儿进行了T-SPOT.TB检测。在128名T-SPOT.TB检测结果明确的婴儿中，T-SPOT.TB阳性的患病率为10.9%[95%置信区间（CI）：6.1-17.7%]。所有婴儿均接种了卡介苗，7.0%感染了HIV-1。婴儿T-SPOT.TB阳性与母亲活动性结核病相关（比值比：15.5，95%CI：1.3-184；P = 0.04）以及婴儿长期发热（>1个月）相关（比值比：18.8，95%CI：1.6-223；P = 0.03）。
我们观察到6个月大的暴露于HIV-1的婴儿中结核感染的患病率很高。对于有活动性结核病高风险的暴露于HIV-1的婴儿，有必要改进结核检测和预防措施。
