title: Prevalence, characteristics, management, and outcome of pulmonary tuberculosis in HIV-infected children in the TREAT Asia pediatric HIV Observational Database (TApHOD).
abstract: A multicenter, retrospective, observational study was conducted to determine prevalence, characteristics, management, and outcome of pulmonary tuberculosis (PTB) in Asian HIV-infected children in the TREAT Asia Pediatric HIV Observational Database (TApHOD). Data on PTB episodes diagnosed during the period between 12 months before antiretroviral therapy (ART) initiation and December 31, 2009 were extracted. A total of 2678 HIV-infected children were included in TApHOD over a 13-year period; 457 developed PTB, giving a period prevalence of 17.1% (range 5.7-33.0% per country). There were a total of 484 PTB episodes; 27 children had 2 episodes each. There were 21 deaths (4.3%). One third of episodes (n=175/484) occurred after ART initiation at a median of 14.1 months (interquartile range [IQR] 2.5-28.8 months). The median (IQR) CD4+ values were 9.0% (3.0-16.0%) and 183.5 (37.8-525.0) cells/mm(3) when PTB was diagnosed. Most episodes (n=424/436, 97.3%) had abnormal radiographic findings compatible with PTB, whereas half (n=267/484, 55.2%) presented with clinical characteristics of PTB. One third of those tested (n=42/122, 34.4%) had bacteriological evidence of PTB. Of the 156 episodes (32.2%) that were accompanied with extrapulmonary TB, pleuritis was the most common manifestation (81.4%). After treatment completion, most episodes (n=396/484, 81.9%) were recorded as having positive outcomes (cured, treatment completed and child well, and improvement). The prevalence of PTB among Asian HIV-infected children in our cohort was high. Children with persistent immunosuppression remain vulnerable to PTB even after ART initiation.
authors.affiliation: 1 Department of Pediatrics, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand .
authors.forename: Tavitiya
authors.initials: T
authors.lastname: Sudjaritruk
authors.forename: Alan
authors.initials: A
authors.lastname: Maleesatharn
authors.forename: Wasana
authors.initials: W
authors.lastname: Prasitsuebsai
authors.forename: Siew Moy
authors.initials: SM
authors.lastname: Fong
authors.forename: Ngoc Oanh
authors.initials: NO
authors.lastname: Le
authors.forename: Thanh Thuy Thi
authors.initials: TT
authors.lastname: Le
authors.forename: Pagakrong
authors.initials: P
authors.lastname: Lumbiganon
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: Nia
authors.initials: N
authors.lastname: Kurniati
authors.forename: Rawiwan
authors.initials: R
authors.lastname: Hansudewechakul
authors.forename: Nik Khairulddin Nik
authors.initials: NK
authors.lastname: Yusoff
authors.forename: Kamarul Azahar Mohd
authors.initials: KA
authors.lastname: Razali
authors.forename: Azar
authors.initials: A
authors.lastname: Kariminia
authors.forename: Annette H
authors.initials: AH
authors.lastname: Sohn
authors.forename: Virat
authors.initials: V
authors.lastname: Sirisanthana
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013183:Sputum / Q000382:microbiology; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents