EFFECTS OF THE HUMAN-IMMUNODEFICIENCY-VIRUS ON TUBERCULOSIS IN CHILDREN

Setting: Human immunodeficiency virus (HIV) infection has altered the epidemiological and clinical profile of tuberculosis (TB) worldwide. I n children however, unlike in adults, very little has been documented about the interaction between the two diseases. Objective: To examine the clinical features and response to TB treatment in children with TB and HIV and compare them with those with TB alone. Design: A prospect ively enrolled case study with systematically selected controls was co nducted between 1992 and 1994 at King George V tuberculosis hospital, in Durban. Forty children with TB and HIV (Group A) were compared with 40 children with TB alone (Group B). The diagnosis of TB was made in accordance with established criteria. Measures of comparison between t he groups included: history of contact with a TB case, clinical presen tation on admission, presence of bacille Calmett-Guerin (BCG) scar, re action to tuberculin test, clinical response to anti-tuberculosis trea tment (mean weight gain per month, improved appetite, resolution of ch est signs, decreasing size of visceromegaly), radiological response to treatment (assessed according to an objective score on admission, at 6 months and on discharge), other associated diseases, nosocomial infe ctions and survival. Results: The mean age of the children in Group A was 25 months and in Group B 31 months. The dearest differences betwee n the groups on admission were clinical features and response to tuber culin testing. Group A were more frequently anergic to tuberculin test ing (P < 0.0001) and more often had symptoms and signs suggestive of T B (P = 0.002). Clinical response to treatment on discharge was worse i n Group A than in Group B (P = 0.005). Radiological response to treatm ent at six months and on discharge was poorer in Group A than in Group B (P = 0.46; P = 0.006, respectively). Six children in group A and no ne in group B died (P = 0.012). The mean duration of treatment (and th erefore period until discharge) was 8.9 months in Group B and 8.5 mont hs in Group A for those who survived. History of contact, evidence of BCG inoculation and nosocomial infections were similar in both groups. Conclusion: HIV infection adversely affects the outcome of TB in chil dren as assessed by response to treatment and survival.