TUBERCULOSIS IN HUMAN IMMUNODEFICIENCY VIRUS-EXPOSED OR VIRUS-INFECTED UNITED-STATES CHILDREN

This study was designed to provide a preliminary assessment of the occ urrence of tuberculosis exposure, infection and disease within a natio nal sample of infants and children with human immunodeficiency virus ( HIV) exposure or infection, and to determine the prevalence of Mycobac terium tuberculosis isolates resistant both to isoniazid and rifampin in these patients or their adult source contacts. A retrospective ques tionnaire survey was conducted of infants and children with HN exposur e or infection evaluated by pediatric HIV referral centers in the Unit ed States comprising the pediatric units or subunits of the Pediatric Acquired Immunodeficiency Syndrome Clinical Trials Group (PACTG). Seve nty of 72 sites during a mean period of 5 (range, 1 to 12) years parti cipated in this study and had provided care for 14038 patients. There were 75 cumulative total cases of tuberculosis disease seen since each site was established. Therapy for asymptomatic infection was given to another 40 children and for tuberculosis exposure to 71 children. Ann ualized case rates mere 478/100000 for sites established in 1990 to 19 99, 117/100000 for 1988 to 1989, 63/100000 for 1986 to 1987 and 58/100 000 for 1981 to 1985 (P = 0.05, Spearman's p test for trend). By compa rison, the 1992 age specific tuberculosis case rate for all U.S. child ren < 5 years was 5.5/100000. Twenty percent of isolates from PACTG pa tients and 15% of isolates from adult source contacts were resistant t o isoniazid and rifampin. In children with HIV exposure or infection, incident case rates of tuberculosis appear to exceed greatly those of comparably aged children in the general population. Annualized case ra tes increased progressively across PACTG sites of increasingly recent establishment, possibly indicating that rates of infection increased o ver time. Infection with and exposure to multiply drug-resistant strai ns was common in PACTG patients. This study has identified the need to monitor tuberculosis trends in HIV-exposed or -infected pediatric pat ients, to determine the circumstances in which these children are expo sed to tuberculosis, to identify opportunities to intervene and to int egrate the needs of these children into national plans for tuberculosi s control.