Tuberculosis in a Spanish cohort of children living with HIV: the CHOTIS study (Childhood HIV & TB study)

Abstract

BACKGROUND: Tuberculosis (TB) is the leading opportunistic infection in children with human immunodeficiency virus (HIV), but is uncommon in low prevalence regions. We aim to describe the changing epidemiology and clinical presentation of TB-HIV co-infection in a cohort of HIV-infected children in Spain.METHODS: Children diagnosed with TB between 1995 and 2016 in the paediatric HIV cohort were identified. The incidence and clinical presentation were compared in three periods: 1995–1999 (P1, before initiation of combined antiretroviral therapy, cART), 2000–2009 (P2, increase in immigration), and 2010–2016 (P3, decrease in immigration).RESULTS: We included 29 TB cases among 1183 children aged <18 years (2.4%, 243/100 000 person-years). The proportion was stable in P1 and P2 (1.3%), but decreased in P3 (0.8%). The median age at TB diagnosis was 6.4 years (IQR 4–10.6); most children in P3 were aged >10 years (20% vs. 23.1% vs. 83.3%, P = 0.01). TB was diagnosed at HIV presentation in 11/29 children (37.9%). Foreign-born children accounted for respectively 0%, 8% and 67% of the total number of children in each period (P ≤ 0.0001). One third had extrapulmonary TB; four children died (13.8%).CONCLUSION: In our cohort, the incidence of TB-HIV co-infection decreased with decline in immigration. In regions with adequate cART coverage and low TB transmission, paediatric TB-HIV coinfection is uncommon, but associated with significant morbidity. Strategies for TB surveillance, diagnosis and treatment in this vulnerable population should be reinforced.

HIV-Associated Tuberculosis in Children and Adolescents: Evolving Epidemiology, Screening, Prevention and Management Strategies

“…Collectively, this data demonstrates that while ART effectively reduces TB risk and improves outcomes among CALHIV in sub-Saharan Africa, the risk remains highly elevated compared to populations without HIV. As a whole, these findings may reflect the persistently high force of TB infection in these settings, as data from low burden settings suggests a more significant decline in HIV-associated TB attributable to ART uptake [9]. This persistent risk of incident TB coupled with an elevated risk of mortality from HIVassociated TB indicates the ongoing need for novel TB screening, diagnostic and preventive strategies for CALHIV.…”