Tuberculosis On the Rise in HIV-infected Children in NYC

      According to a study from the United States, tuberculosis has increased in HIV infected children in New York city.

      "Tuberculosis disease incidence increased sharply in New York City (NYC) in the late 1980s in children and adults," stated P. Thomas and colleagues, New York City Department of Health

      Since TB infection in HIV + adults has been well-studied, Thomas et al. looked at coinfection in children in New York City. They published their findings in the Pediatric Infectious Disease Journal ("Tuberculosis in human immunodeficiency virus-infected and human immunodeficiency virus-exposed children in New York City," Pediat Inf Dis J , 2000;19(8):700-706).

      The researchers collected TB incidence data by retrospective chart abstraction in a cohort of HIV exposed and infected children enrolled in a longitudinal study of HIV. Chart review or matching of HIV infected and HIV exposed children to the NYC Tuberculosis Registry was used to confirm TB cases. For comparison, data on non-HIV infected children reported from 1989 to 1995 in the NYC Tuberculosis Registry were evaluated.

      "Tuberculosis disease was found in 45 (3%) of 1426 HIV infected children (0.61 per 100 child years of observation) and in 5 (0.5%) of 1,085 HIV exposed uninfected children (0.2 per 100 child years)," stated Thomas et al. "Thirty percent of children were evaluated for HIV only after presenting with tuberculosis."

      The data showed that children with tuberculosis and HIV were more likely than other age-matched HIV infected children to have decreased CD4 + T lymphocyte counts (66% vs. 37%, P =0.02). These children were also more likely than other children in NYC with tuberculosis to have culture-confirmed and extrapulmonary tuberculosis. In this cohort of children, eight of 21 deaths in HIV infected children with tuberculosis were attributed to TB.

      "During a period of high tuberculosis incidence in NYC, 3% of HIV infected children in our cohort had tuberculosis, higher than the rate in uninfected children born to HIV positive mothers in the same cohort," Thomas et al. concluded. "Because of this association, HIV infected children with pulmonary illness should be tested for tuberculosis; and all children with tuberculosis should be tested for HIV."

      The corresponding author for this report is P. Thomas, New York City Department of Health, 346 Broadway, Room 706, New York, New York 10013, USA.

      A search of the www.NewsRx.com online database using the terms "tuberculosis" and "HIV" and "coinfection" yielded 228 articles.

      Key points reported in this study are: * HIV infected children in New York city are at risk of tuberculosis * Children coinfected with HIV/tuberculosis generally have poorer immunological health * All HIV infected children with pulmonary symptoms should be tested for tuberculosis

      This article was prepared by AIDS Weekly editors from staff and other reports.

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