title: Bacteriologically confirmed tuberculosis in HIV-infected infants: disease spectrum and survival.
abstract: BACKGROUND
  The human immunodeficiency virus (HIV) has resulted in epidemiological shifts with an emergence of tuberculosis (TB) amongst HIV-infected women and infants. There are limited data on the TB disease spectrum and outcome amongst HIV-infected infants.
  
  
  OBJECTIVE
  We describe the clinical characteristics, treatment and survival of HIV-infected infants with culture-confirmed TB.
  
  
  METHODS
  This retrospective hospital-based study from Cape Town, South Africa, used routine laboratory-based surveillance among infants diagnosed with culture-confirmed TB from 1 January 2004 to 31 December 2006. Folder and chest radiographic review were completed and vitality status established. TB was classified as pulmonary, extra-pulmonary or disseminated disease.
  
  
  RESULTS
  Of 52 infants, 37 (71.1%) had pulmonary, 2 (3.9%) extra-pulmonary only, 7 (13.5%) pulmonary and extra-pulmonary and 6 (11.5%) disseminated TB. Forty-six (88.5%) were started anti-tuberculosis therapy; 37 (71.2%) received antiretroviral therapy (ART) and 17 (32.7%) died, 10 (19.2%) of whom never started ART. HIV stage 4 disease was associated with death. TB treatment outcome was poorly documented.
  
  
  CONCLUSIONS
  TB is associated with advanced HIV disease and high mortality in HIV-infected infants. Missed opportunities for initiation of ART were frequent. Although the effects of young age, TB disease spectrum and HIV co-infection are difficult to distinguish, our findings support the initiation of early ART in HIV-infected infants with TB.
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa. dommisse@sun.ac.za
authors.forename: C A
authors.initials: CA
authors.lastname: Wiseman
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
authors.forename: M F
authors.initials: MF
authors.lastname: Cotton
authors.forename: R P
authors.initials: RP
authors.lastname: Gie
authors.forename: T
authors.initials: T
authors.lastname: Jennings
authors.forename: A
authors.initials: A
authors.lastname: Whitelaw
authors.forename: P
authors.initials: P
authors.lastname: Roux
authors.forename: A C
authors.initials: AC
authors.lastname: Hesseling
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D016019:Survival Analysis; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy / Q000401:mortality* / Q000517:prevention & control; D032581:Tuberculosis Vaccines / Q000008:administration & dosage
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents; D032581:Tuberculosis Vaccines