HIV-1 co-infection in children hospitalised with tuberculosis in South Africa.
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.
Madhi
S A
SA
Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa. shabirm@mail.saimr.wits.ac.za
Huebner
R E
RE
Doedens
L
L
Aduc
T
T
Wesley
D
D
Cooper
P A
PA
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