Dual HIV/TB infection common in S. African infants

By C. Vidya Shankar, MD

CHENNAI, India (Reuters Health) - HIV-positive infants are over 20 times more likely to develop tuberculosis than their HIV-negative counterparts, researchers from South Africa report in the current issue of Clinical Infectious Diseases.

“The current status of TB amongst HIV-infected children is still very high,” Dr. Anneke Hesseling from Cape Town told Reuters Health. “This burden is not always accurately assessed because it can be difficult to confirm the diagnosis of TB in young children,” she added.

In their prospective study, Hesseling from the Desmond Tutu TB Center, Stellenbosch University, and her team analyzed the prevalence of tuberculosis and HIV among infants attending their hospital in Western Cape province between 2004 and 2006.

During the study period, 245 infants were confirmed as having tuberculosis, the investigators report. Of these, 53 (21.6 percent) infants were HIV positive, 122 (49.8 percent) HIV negative, while the others were untested, they note.

The incidence of tuberculosis was 1,596 per 100,000 population among HIV-positive infants and 65.9 per 100,000 among HIV-negative infants, the researchers estimated.

“HIV-infected infants were at a 24.1-fold higher risk of pulmonary tuberculosis and a 17.1-fold higher risk of disseminated tuberculosis,” they report.

Increased exposure to tuberculosis, HIV-associated immunosuppression and reduced efficacy of the BCG vaccine could explain the increased risk of tuberculosis among these infants, Hesseling suggested.

“A very important strategy to reduce the TB burden amongst infants born to HIV- infected women is to implement TB screening amongst pregnant women,” Hesseling commented.

In addition, routine HIV testing of infants with tuberculosis, prophylactic treatment for TB, improved access to HIV treatment and newer vaccines could help reduce the burden, she added.

SOURCE: Clinical Infectious Diseases, January 1, 2009.

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