K-RITH’s Farina Karim, Gary Parker and Alex Pym presented a poster on their research into tuberculosis recurrence in children at the recent South African Aids Conference in Durban.
TB recurrence is defined as a new TB episode occurring after cure, or after treatment completion for a first or prior TB episode. While we know that HIV infected adults are at an increased risk of TB recurrence, very little is known about it in the paediatric population.
Karim and Parker, both senior research coordinators in K-RITH’s Clinical Research Core, and Pym, a K-RITH Associate Investigator, hypothesised that children living with HIV are more likely than HIV-uninfected children to have TB recurrence in a setting with high TB and HIV incidence.
They conducted a retrospective cohort study on all patients under the age of 18 years old who were seen at the Prince Cyril Zulu Communicable Disease Centre between 2005 and 2012, with a follow-up done in December 2013.
The researchers found that recurrence of TB was highest in children living with HIV, when compared to HIV-uninfected children.
The study’s findings emphasise the importance of close clinical follow-up for children living with HIV.
Read the abstract below:
HIV INFECTION AND TUBERCULOSIS RECURRENCE IN A SOUTH AFRICAN PAEDIATRIC COHORT
Background: HIV-infected adults are at increased risk of tuberculosis (TB) recurrence, but little is known about TB recurrence in paediatric populations. We hypothesized that children living with HIV would be more likely than HIV-uninfected children to have TB recurrence in a setting with high TB and HIV incidence.
Methods: We conducted a retrospective cohort study of all TB patients age <18 years who presented to the Prince Cyril Zulu Communicable Diseases Clinic (PCZCDC) in Durban, South Africa from 01/2005–12/2012. Follow-up was through 12/2013. We defined TB recurrence as an episode of TB that occurred after TB treatment completion or cure of the previous episode.
Results: During the study period, 45,633 TB patients presented for care at PCZCDC clinic, 5,502 (12%) of whom were age <18 years at their first TB episode. A total of 164 (3%) children had at least one episode of recurrent TB. HIV status was available for 30% of children. Children with known HIV status were more likely to have TB recurrence (7% vs 1%, p<0.001). Among 1,671 children with known HIV status, 1,021 (61%) were HIV seropositive. In a Cox proportional hazards model adjusting for age, sex, and race, children living with HIV were more likely to have TB recurrence than HIV-negative children (Hazard ratio [HR] 2.6, 95% confidence interval [CI] 1.6-4.2, p<0.001).
Conclusions: Recurrence of TB was highest in children with children living with HIV when compared to HIV-uninfected children, emphasizing the importance of close clinical follow-up for children living with HIV.