HAART and risk of tuberculosis in HIV-infected South African children: a multi-site retrospective cohort.
METHODS
Four human immunodeficiency virus (HIV) clinics located at South African tertiary hospitals.


OBJECTIVE
To assess the effectiveness of highly active antiretroviral therapy (HAART) in reducing incident tuberculosis (TB) in HIV-infected children.


METHODS
Retrospective cohort.


RESULTS
A total of 1132 children's records were included in the study. At entry to the cohort, the median (interquartile range [IQR]) age, CD4%, CD4 count and viral load of all children was respectively 6.3 years (4.1-8.8), 15% (9.0-22.2), 576 cells/mm(3) (287-960) and 160 000 copies/ml (54 941.5-449 683); 75.9% were started on HAART. The male:female ratio was 1:1, and median follow-up time was 1.7 years. In children whose follow-up included both pre-HAART and on-HAART periods, the incidence of clinically diagnosed TB was respectively 21.1 per 100 person-years (py; 95%CI 18.2-24.4) and 6.4/100 py (95%CI 4.8-8.1), and when restricted to confirmed cases, respectively 3.1/100 py (95%CI 2.2-4.2) and 0.8/100 py (95%CI 0.5-1.4). Only 23% of all cases of TB were microbiologically confirmed. Multivariate analyses showed that HAART reduced incident TB by approximately 70%, both for confirmed and all TB cases.


CONCLUSIONS
In this high TB burden country, the incidence of diagnosis of TB in HIV-infected children is at least as high as that of adults. HAART reduces incident TB, but further prospective TB preventive and diagnostic studies are urgently needed in children.
Martinson
Neil A
NA
Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa. martinson@hivsa.com
Moultrie
H
H
van Niekerk
R
R
Barry
G
G
Coovadia
A
A
Cotton
M
M
Violari
A
A
Gray
G E
GE
Chaisson
R E
RE
McIntyre
J A
JA
Meyers
T
T
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000517:prevention & control*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control*