431. High Prevalence of Tuberculosis in a Cohort of HIV-infected Children in Northeast Thailand
Session: Poster Abstract Session: HIV Challenges and Complications
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

Tuberculosis(TB) is one of the most common opportunistic infections in HIV-infected children. Pulmonary parenchymal disease and intrathoracic adenopathy are the most common manifestations of which the diagnosis is difficult.  Early diagnosis and treatment of TB in HIV-infected patient is important.

Methods: 

HIV-infected children aged less than 15 year-old attended Pediatric HIV Clinic, Srinagarind Hospital, Khon Kaen University  who were treated for tuberculosis(TB) were included in this study.  History of TB in family and routine chest X-ray were obtained in every patient . The diagnosis of TB was based on history of TB contact and abnormal chest X-ray that could not be explained by other causes. The demographic data, type of TB, prior antiretroviral therapy(ART) use and outcome were described.

Results: 

Between  January 1998 to March 2011, 407 cases of HIV-infected children attended the clinic. More than 90% were perinatally-HIV-infected. 161 cases had the diagnosis of TB, giving the prevalence of 39.6%. 46.6% were male. In an analysis of the first 60 cases of TB, 20 out of 52 (38.5%) cases with reliable history on TB contact reported at least 1 family member with TB, almost all of them were parents who were also HIV-infected. Types of TB included pulmonary( 55 cases), pleural (3 cases), miliary TB and TB meningitis (1 case each). Only 2 out of 60 (3.3%) cases had the acid-fast bacilli smear positive.  At the time of TB diagnosis, 70% of cases had not been initiated with highly active antiretroviral therapy. The treatment of TB included isoniazid, rifampicin, pyrazinamide and ethambutol or streptomycin for 2 months, followed by isoniazid and rifampicin for another 7 or 10 months. The mortality in TB and non-TB group were 6.7% and 10.7%, respectively. No case of immune reconstitution was found in this cohort.

Conclusion: 

Diagnosis and treatment of TB in HIV-infected children before initiation of ART help to simplify the ART regimen and also to decrease pill burden which result in good outcome.


Subject Category: H. HIV/AIDS and other retroviruses

Pagakrong Lumbiganon, MD.1, Pope Kosalaraksa, MD.1 and Piangjit Tharnpaisarn, RN2, (1)Pediatrics, Khon Kaen University, Khon Kaen, Thailand, (2)Khon Kaen University, Khon Kaen, Thailand

Disclosures:

P. Lumbiganon, None

P. Kosalaraksa, None

P. Tharnpaisarn, None

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