title: Diagnosed tuberculosis during the follow-up of a cohort of human immunodeficiency virus-infected children in Abidjan, Côte d'Ivoire: ANRS 1278 study.
abstract: BACKGROUND
  Most data on tuberculosis in human immunodeficiency virus (HIV)-infected children in Africa come from hospital-based and cross-sectional studies.
  
  
  OBJECTIVE
  To estimate the incidence of tuberculosis in HIV-infected children participating in an observational cohort.
  
  
  METHODS
  HIV-infected children in Abidjan, Côte d'Ivoire, are followed in a prospective cohort. At enrollment, all children had a physical examination, CD4 lymphocyte counts, chest radiograph and a tuberculin test. Quarterly follow-up visits are organized. All patients with suspected tuberculosis undergo specific investigations including gastric aspiration and culture. All isolates are tested for susceptibility.
  
  
  RESULTS
  From October 2000 to December 2003, 129 girls and 153 boys were recruited. Of children without a current or previous diagnosis of tuberculosis, 6.5% (13 of 199) had a tuberculin test result of >5 mm, compared with 17.5% of children (10 of 57) with current or previous tuberculosis (P < 0.02). Forty-eight children (17%) had a history of treated tuberculosis, and 27 children were being treated for tuberculosis at enrollment or during the first month of follow-up. Eleven children were diagnosed with tuberculosis after the first month of follow-up, and the diagnosis of mycobacterial infection was confirmed in 7 cases. Of 5 tested isolates of Mycobacterium tuberculosis, 3 were resistant to at least 1 antitubercular drug. Cumulative incidence of tuberculosis was 2060/100,000 at 12 months, 3390/100,000 at 2 years and 5930/100,000 at 3 years. The 3-year risk was 12,400/100,000 in immunocompromised children (CD4 <15%) and 3300/100,000 in other children (P < 0.0001).
  
  
  CONCLUSIONS
  The risk of tuberculosis among HIV-infected children in Côte d'Ivoire is strongly associated with the degree of immunodeficiency in HIV infection.
authors.affiliation: Programme Enfant Yopougon, PACCI, Abidjan, Côte d'Ivoire.
authors.forename: Narcisse
authors.initials: N
authors.lastname: Elenga
authors.forename: Kouakou Alain
authors.initials: KA
authors.lastname: Kouakoussui
authors.forename: Dominique
authors.initials: D
authors.lastname: Bonard
authors.forename: Patricia
authors.initials: P
authors.lastname: Fassinou
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Anaky
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Wemin
authors.forename: Flore
authors.initials: F
authors.lastname: Dick-Amon-Tanoh
authors.forename: François
authors.initials: F
authors.lastname: Rouet
authors.forename: Véronique
authors.initials: V
authors.lastname: Vincent
authors.forename: Philippe
authors.initials: P
authors.lastname: Msellati
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D000293:Adolescent; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011446:Prospective Studies; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology