title: High prevalence of tuberculosis infection in HIV-1 exposed Kenyan infants.
abstract: BACKGROUND
  Infants born to HIV-1 infected mothers may have increased risk for tuberculosis (TB), but the prevalence of TB infection in this population is undefined. In contrast to tuberculin skin tests that are confounded by recent bacille Calmette-Guérin (BCG) vaccination, TB interferon gamma release assays (IGRAs) do not cross-react with BCG and enable detection of TB infection in infancy.
  
  
  METHODS
  In a nested observational cohort of HIV-1 infected Kenyan mothers and their infants, we conducted T-SPOT.TB assays on cryopreserved peripheral blood mononuclear cells from 6-month-old infants without prior active TB. Maternal and infant correlates of infant TB infection were assessed.
  
  
  RESULTS
  One hundred and eight-two infants were tested with T-SPOT.TB. Of 128 infants with determinate T-SPOT.TB results, the prevalence of a positive T-SPOT.TB was 10.9% [95% confidence interval (CI): 6.1-17.7%]. All infants were BCG-vaccinated and 7.0% were HIV-1 infected. Positive infant T-SPOT.TB was associated with maternal active TB (odds ratio: 15.5, 95% CI: 1.3-184; P = 0.04) and prolonged infant fever (>1 month) (odds ratio: 18.8, 95% CI: 1.6-223; P = 0.03).
  
  
  CONCLUSIONS
  We observed a high prevalence of TB infection in 6-month-old HIV-1 exposed infants. Improved TB detection and prevention are warranted in HIV-1 exposed infants at high risk for active TB disease.
authors.affiliation: From the *Department of Pediatrics, University of Washington; †Seattle Children's Hospital, Seattle, WA; ‡Department of Paediatrics, University of Nairobi, Nairobi, Kenya; §Department of Epidemiology; ¶Department of Medicine; and ‖Department of Global Health, University of Washington, Seattle, WA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Cranmer
authors.forename: Mercy
authors.initials: M
authors.lastname: Kanyugo
authors.forename: Sasi R
authors.initials: SR
authors.lastname: Jonnalagadda
authors.forename: Barbara
authors.initials: B
authors.lastname: Lohman-Payne
authors.forename: Bess
authors.initials: B
authors.lastname: Sorensen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maleche Obimbo
authors.forename: Dalton
authors.initials: D
authors.lastname: Wamalwa
authors.forename: Grace C
authors.initials: GC
authors.lastname: John-Stewart
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D015497:HIV-1; D006801:Humans; D007223:Infant; D059425:Interferon-gamma Release Tests; D007630:Kenya / Q000453:epidemiology; D007963:Leukocytes, Mononuclear / Q000382:microbiology; D018811:Maternal Exposure; D009035:Mothers / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D055815:Young Adult