Walters Elisabetta, Duvenhage Joanie, Draper Heather R, Hesseling Anneke C, Van Wyk Susan S, Cotton Mark F, Rabie Helena
Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa.
Department of Paediatrics and Child Health, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa.
Arch Dis Child. 2014 Nov;99(11):998-1003. doi: 10.1136/archdischild-2013-305509. Epub 2014 Jun 17.
Early initiation of antiretroviral therapy (ART) in HIV-infected infants reduces mortality and opportunistic infections including tuberculosis (TB). However, young HIV-infected children remain at high risk of TB disease following mycobacterial infection. We document the spectrum of TB disease in HIV-infected children <2 years of age on ART.
Retrospective cohort study; records of children <2 years of age initiating routine ART at Tygerberg Children's Hospital, Cape Town, January 2003-December 2010 were reviewed. Clinical data at ART initiation (baseline) and TB episodes after ART initiation, to June 2012, were recorded. TB immune reconstitution syndrome (TB-IRIS) and incident TB were defined as TB diagnosed within 3 months, and >3 months after, ART initiation respectively. Baseline characteristics were compared in children with TB-IRIS and those with incident TB.
In 494 children, median follow-up time on ART was 10.7 months. Fifty-five TB treatment episodes occurred after ART initiation: 23 (42%) TB-IRIS (incidence 21.9/100 person years (py)) and 32 (58%) incident TB (incidence 3.9/100 py). Children with TB-IRIS and those with incident TB had similar baseline characteristics. Eight of 10 cases of extrapulmonary TB were severe: 4 IRIS (2 meningitis, 1 disseminated, 1 pericarditis) and 4 incident cases (1 each miliary, meningitis, pericarditis and spinal). Fifty-one children (10%) died (mortality rate 5.96/100 py). Starting ART at <1 year of age approached significance as a risk factor for TB-IRIS (adjusted OR (AOR) 8.64, p=0.06); weight-for-age Z score <-2 predicted death (AOR 6.37, p<0.001).
Severe TB manifestations were observed among young HIV-infected children on ART.
对感染人类免疫缺陷病毒（HIV）的婴儿尽早开始抗逆转录病毒治疗（ART）可降低死亡率及包括结核病（TB）在内的机会性感染风险。然而，感染HIV的幼儿在发生分枝杆菌感染后仍有很高的患结核病风险。我们记录了接受ART治疗的2岁以下HIV感染儿童的结核病谱。
回顾性队列研究；对2003年1月至2010年12月在开普敦泰格伯格儿童医院开始接受常规ART治疗的2岁以下儿童的记录进行审查。记录ART开始时（基线）的临床数据以及至2012年6月ART开始后的结核病发作情况。结核病免疫重建综合征（TB-IRIS）和新发结核病分别定义为在ART开始后3个月内和3个月后诊断出的结核病。比较发生TB-IRIS的儿童和新发结核病儿童的基线特征。
494名儿童中，ART的中位随访时间为10.7个月。ART开始后发生了55次结核病治疗事件：23例（42%）为TB-IRIS（发病率21.9/100人年（py）），32例（58%）为新发结核病（发病率3.9/100 py）。发生TB-IRIS的儿童和新发结核病儿童具有相似的基线特征。10例肺外结核病例中有8例病情严重：4例为IRIS（2例脑膜炎、1例播散性、1例心包炎），4例为新发病例（各1例粟粒性、脑膜炎、心包炎和脊柱结核）。51名儿童（10%）死亡（死亡率5.96/100 py）。在1岁前开始ART作为TB-IRIS的危险因素接近显著水平（调整后比值比（AOR）8.64，p = 0.06）；年龄别体重Z评分<-2预测死亡（AOR 6.37，p<0.001）。
在接受ART治疗的感染HIV的幼儿中观察到严重的结核病表现。
