Tuberculosis and HIV Coinfection Admissions and Outcome in Children at a Nigerian Tertiary Hospital.

Abstract

Background: Tuberculosis and HIV are significant contributors to morbidity and mortality in children living in developing countries. Factors associated with morbidity in tuberculosis and HIV coinfections have not been sufficiently exhaustively studied.

Aim: The aim of this study was to study the pattern of presentation and outcome of tuberculosis in HIV infected children and identify factors associated with outcome of management.

Methodology: Consecutive children diagnosed with tuberculosis and HIV coinfections at the pediatric unit of UNIOSUN teaching hospitals were studied. Necessary data were obtained and analyzed.

Results: A total of 36 children with HIV and tuberculosis coinfection were studied, with age ranging from 3 months to 17 years (mean 6.7 ± 4.3 years). The 36 children consisted of 21 boys (58.3%) boys and 15 (53.6%) girls. The forms of tuberculosis diagnosed were pulmonary 23 (63.9%). Disseminated and abdominal tuberculosis were diagnosed in 6 (16.7%) and 4 (11.1%) children, respectively. Miliary, meningeal forms of tuberculosis with tuberculoma were diagnosed in 1 (2.7%) child each. Twelve (33.3%) children exhibited treatment failure to Category I antituberculous (Anti-Tb) drugs. The majority 8 (66.7%) of the 12 with Category 1 treatment failure had underlying AIDS. Category I Anti-Tb therapy treatment failure was significantly associated with immunological suppression, (CD4 <200 cells/ml, poor viral load suppression (viral load >1000copies/mL, disseminated disease and AIDS (P < 0.01). Six deaths (16.7%) were recorded in the course of the study, whereas 30 (83.3%) survived.

Conclusion: Pediatric tuberculosis HIV coinfection should not be managed with Category 1 (Short course) Anti-Tb therapy in HIV tuberculosis coinfected children with associated immunosuppression or unsuppressed viral loads or with disseminated tuberculosis or AIDS.