MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK; Imperial College Healthcare NHS Trust, London, UK.
MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK.
Lancet HIV. 2015 Dec;2(12):e530-9. doi: 10.1016/S2352-3018(15)00200-3. Epub 2015 Oct 29.
Tuberculosis is the most common serious co-infection in people living with HIV worldwide, but little is known about its incidence in HIV-infected children living in high-resource settings with low tuberculosis prevalence. We aimed to assess the incidence and prevalence of tuberculosis in children with HIV living in the UK and Ireland to understand rates, risk factors, and outcomes of the disease in this group.
We did an analysis of children enrolled in CHIPS, an observational multicentre cohort of children receiving HIV care in the UK and Ireland. We assessed characteristics and prevalence of tuberculosis at baseline, measured incidence of disease through the follow-up period using the CHIPS database, and calculated associated risk factors in these children with multivariable logistic and Cox regression models.
Between Jan 1, 1996, to Sept 18, 2014, data for 1848 children with 14 761 years of follow-up were reported to CHIPS. 57 (3%) children were diagnosed with tuberculosis: 29 children had tuberculosis at presentation (prevalent tuberculosis) and 29 had the disease diagnosed during follow-up (incident tuberculosis), including one child with recurrent tuberculosis events. Median age at diagnosis was 9 years (IQR 5-12). 25 (43%) children had pulmonary tuberculosis, 24 (41%) had extrapulmonary tuberculosis with or without pulmonary involvement, and the remainder (n=9; 16%) had unspecified-site tuberculosis. The overall incidence rate for the follow-up period was 196 cases per 100 000 person-years (95% CI 137-283). In our multivariable model, tuberculosis at presentation was associated with more severe WHO immunological stage at baseline (odds ratio 0·25, 95% CI 0·08-0·74; p=0·0331; for none vs severe) and being born abroad (odds ratio 0·28, 0·10-0·73; p=0·0036; for UK and Ireland vs abroad). Incident tuberculosis was associated with time-updated more severe WHO immunological stage (hazard ratio 0·15, 95% CI 0·06-0·41; p=0·0056; for none vs severe) and older age at baseline (1·11, 0·47-2·63; p=0·0027; for age >10 years vs 5-9 years).
Tuberculosis rates in HIV-infected children in the UK and Ireland were higher than those reported in the general paediatric population. Further study is warranted of tuberculosis screening and preventive treatment for children at high-risk of this disease to avoid morbidity and mortality in this population.
NHS England, PENTA Foundation.
结核病是全世界艾滋病毒感染者中最常见的严重合并感染，但在结核病发病率较低的高资源环境中，艾滋病毒感染者儿童的发病率知之甚少。我们旨在评估英国和爱尔兰艾滋病毒感染儿童中结核病的发病率和患病率，以了解该人群中该病的发病率、危险因素和结局。
我们对在英国和爱尔兰接受艾滋病毒护理的儿童进行了 CHIPS 观察性多中心队列研究。我们在基线时评估了结核病的特征和患病率，通过 CHIPS 数据库在随访期间测量疾病的发病率，并使用多变量逻辑回归和 Cox 回归模型计算了这些儿童的相关危险因素。
1996 年 1 月 1 日至 2014 年 9 月 18 日，向 CHIPS 报告了 1848 名儿童（14-761 岁）的数据。57 名（3%）儿童被诊断患有结核病：29 名儿童在就诊时患有结核病（现患结核病），29 名儿童在随访期间被诊断患有结核病（新发结核病），包括一名儿童患有复发性结核病事件。诊断时的中位年龄为 9 岁（IQR 5-12）。25 名（43%）儿童患有肺结核，24 名（41%）患有肺外结核病，伴有或不伴有肺部受累，其余 9 名（16%）患有未指定部位的结核病。整个随访期间的发病率为每 100000 人年 196 例（95%CI 137-283）。在我们的多变量模型中，就诊时的结核病与基线时更严重的世卫组织免疫分期有关（比值比 0·25，95%CI 0·08-0·74；p=0·0331；无 vs 严重），与在国外出生有关（比值比 0·28，95%CI 0·10-0·73；p=0·0036；英国和爱尔兰 vs 国外）。新发结核病与时间更新的更严重的世卫组织免疫分期有关（风险比 0·15，95%CI 0·06-0·41；p=0·0056；无 vs 严重）和基线时年龄较大（1·11，0·47-2·63；p=0·0027；年龄>10 岁 vs 5-9 岁）。
英国和爱尔兰艾滋病毒感染儿童的结核病发病率高于一般儿科人群报告的发病率。需要进一步研究结核病筛查和高危儿童的预防性治疗，以避免该人群的发病率和死亡率。
英国国民保健署，PENTA 基金会。
