title: Tuberculosis Infection in Early Childhood and the Association with HIV-exposure in HIV-uninfected Children in Rural Uganda.
abstract: BACKGROUND
  In high tuberculosis (TB) burden countries, a significant proportion of the latent TB reservoir is established by the age 5 years. There are critical knowledge gaps in our understanding of the age-specific prevalence of TB infection and the influence of HIV exposure on TB infection in the first 5 years of life among HIV-uninfected children in sub-Saharan Africa.
  
  
  METHODS
  We measured TB infection with the Quantiferon Gold-in-Tube (QFT) and tuberculin skin tests (TST) in 447 children ≤60 months and their 284 HIV-infected and IV-uninfected mothers in rural Uganda.
  
  
  RESULTS
  The overall prevalence of TB infection in children ≤60 months by TST was 24% (95% confidence intervals [CI]: 19.9-27.9). The prevalence of TST positivity was highest among children in their first year of life (36%; 95% CI: 26.0-45.9) and declined with age to 19% at 36-60 months of age, χ test for trend P = 0.014. In contrast, 4% (95% CI: 1.9-5.87%) of children had a positive QFT, and there was no trend detected with age, P = 0.576. QFT positivity was detected as early as 5 months. HIV-exposed uninfected children had significantly higher odds of TB infection by QFT (odds ratio [OR]: 21.2; P = 0.008; 95% CI: 2.2-204.7) or positive TST or QFT (OR, 2.4; P = 0.020; 95% CI: 1.2-5.1) compared with HIV-unexposed uninfected children, adjusting for age, BCG vaccination and a positive maternal TST or QFT.
  
  
  CONCLUSIONS
  An appreciable prevalence of TB infection was detected in early childhood. HIV-exposed uninfected children have a higher risk for TB infection compared with children born to HIV-uninfected mothers.
authors.affiliation: From the *HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; †Makerere University-University of California, San Francisco (MU-UCSF) Research Collaboration, Kampala, Uganda; ‡Department of Pediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; §Infectious Diseases Division, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; ¶Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; and ‖Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, California.
authors.forename: Carina
authors.initials: C
authors.lastname: Marquez
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chamie
authors.forename: Jane
authors.initials: J
authors.lastname: Achan
authors.forename: Anne F
authors.initials: AF
authors.lastname: Luetkemeyer
authors.forename: Mary
authors.initials: M
authors.lastname: Kyohere
authors.forename: Jaffer
authors.initials: J
authors.lastname: Okiring
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: Diane V
authors.initials: DV
authors.lastname: Havlir
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D005260:Female; D015658:HIV Infections; D006801:Humans; D007223:Infant; D059425:Interferon-gamma Release Tests; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D018570:Risk Assessment; D012424:Rural Population; D014374:Tuberculin Test; D014376:Tuberculosis / Q000453:epidemiology*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult