High incidence of tuberculosis among HIV-infected infants: Evidence from a South African population-based study highlights the need for improved tuberculosis control strategies
Date
2009
Authors
Hesseling A.C.
Cotton M.F.
Jennings T.
Whitelaw A.
Johnson L.F.
Eley B.
Roux P.
Godfrey-Faussett P.
Schaaf H.S.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background. There are limited population-based estimates of tuberculosis incidence among human immunodeficiency virus (HIV)-infected and HIV-uninfected infants aged ≤12 months. We aimed to estimate the population-based incidence of culture-confirmed tuberculosis among HIV-infected and HIV-uninfected infants in the Western Cape Province, South Africa. Methods. The incidences of pulmonary, extrapulmonary, and disseminated tuberculosis were estimated over a 3-year period (2004-2006) with use of prospective representative hospital surveillance data of the annual number of culture-confirmed tuberculosis cases among infants. The total number of HIV-infected and HIV-uninfected infants was calculated using population-based estimates of the total number of live infants and the annual maternal HIV prevalence and vertical HIV transmission rates. Results. There were 245 infants with culture-confirmed tuberculosis. The overall incidences of tuberculosis were 1596 cases per 100,000 population among HIV-infected infants (95% confidence interval [CI], 1151-2132 cases per 100,000 population) and 65.9 cases per 100,000 population among HIV-uninfected infants (95% CI, 56-75 cases per 100,000 population). The relative risk of culture-confirmed tuberculosis among HIV-infected infants was 24.2 (95% CI, 17-34). The incidences of disseminated tuberculosis were 240.9 cases per 100,000 population (95% CI, 89-433 cases per 100,000 population) among HIV-infected infants and 14.1 cases per 100,000 population (95% CI, 10-18 cases per 100,000 population) among HIV-uninfected infants (relative risk, 17.1; 95% CI, 6-34). Conclusions. This study indicates the magnitude of the tuberculosis disease burden among HIV-infected infants and provides population-based comparative incidence rates of tuberculosis among HIV-infected infants. This high risk of tuberculosis among HIV-infected infants is of great concern and may be attributable to an increased risk of tuberculosis exposure, increased immune-mediated tuberculosis susceptibility, and/or possible limited protective effect of bacille Calmette-Guérin vaccination. Improved tuberculosis control strategies, including maternal tuberculosis screening, contact tracing of tuberculosis-exposed infants coupled with preventive chemotherapy, and effective vaccine strategies, are needed for infants in settings where HIV infection and tuberculosis are highly endemic. © 2008 by the Infectious Diseases Society of America. All rights reserved.
Description
Keywords
BCG vaccine, article, bacterium culture, CD4 lymphocyte count, CD4+ T lymphocyte, confidence interval, disease predisposition, disease surveillance, disease transmission, extrapulmonary tuberculosis, female, high risk infant, human, Human immunodeficiency virus infected patient, Human immunodeficiency virus infection, incidence, infant, lung tuberculosis, major clinical study, male, maternal care, miliary tuberculosis, population based case control study, prevalence, priority journal, prospective study, risk factor, screening, South Africa, tuberculosis, HIV Infections, Humans, Incidence, Infant, Infant, Newborn, Mycobacterium tuberculosis, South Africa, Tuberculosis
Citation
Clinical Infectious Diseases
48
1
48
1