title: HIV-1 co-infection in children hospitalised with tuberculosis in South Africa.
abstract: METHODS
  Hospitals associated with the Department of Paediatrics at the University of the Witwatersrand, Johannesburg, South Africa.
  
  
  OBJECTIVE
  To define the prevalence of human immunodeficiency virus (HIV) co-infection and differences in clinical presentation between HIV-infected and non-infected hospitalised children with tuberculosis.
  
  
  METHODS
  Children were prospectively enrolled between August 1996 and January 1997.
  
  
  RESULTS
  Of 161 children enrolled, 42% were HIV-infected, including 67/137 with pulmonary tuberculosis (PTB) and 1/24 with extra-pulmonary disease (EPTB). Positive microscopy or bacteriology did not differ by HIV status for children with either PTB or EPTB. Although age did not differ between HIV-infected and non-infected children with PTB, non-HIV-infected children with EPTB were significantly older than those with PTB only (median age 32 months vs 14.5 months, P = 0.004). Chronic weight loss, malnutrition and the absence of BCG scarring were more common in HIV-infected children with PTB. HIV-infected children were also more likely to show cavitation (P = 0.001) and miliary TB (P = 0.01) on chest X-ray. Reactivity to tuberculin (> or = 5 mm and > or = 10 mm in HIV-infected and non-infected children, respectively) was significantly lower in HIV-infected children, as were CD4+ lymphocyte levels. The mortality rate during the study was 13.4% in HIV-infected children compared with 1.5% in non-HIV-infected children (P = 0.03).
  
  
  CONCLUSIONS
  There is a high prevalence of HIV co-infection in children with TB. Progressive PTB and death are more common in HIV-infected children. Tuberculin skin testing is of limited use in screening for TB in HIV-infected children even when using a cut-point of > or = 5 mm.
authors.affiliation: Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa. shabirm@mail.saimr.wits.ac.za
authors.forename: S A
authors.initials: SA
authors.lastname: Madhi
authors.forename: R E
authors.initials: RE
authors.lastname: Huebner
authors.forename: L
authors.initials: L
authors.lastname: Doedens
authors.forename: T
authors.initials: T
authors.lastname: Aduc
authors.forename: D
authors.initials: D
authors.lastname: Wesley
authors.forename: P A
authors.initials: PA
authors.lastname: Cooper
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D000293:Adolescent; D017677:Age Distribution; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016001:Confidence Intervals; D003906:Developing Countries; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012882:Skin Tests; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology