HIV-TB co-infection in children: associated factors and access to HIV services in Lagos,Nigeria

Background: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The World Health Organization estimates that the prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the access to HIV services of HIV-TB co-infected children.Methods: A retrospective review of data of children diagnosed with TB in Lagos State, Nigeria from 1 January 2012 to 31 December 2013.Results: A total of 1199 children aged between 0 and 14 years were diagnosed with TB. Of 1095 (91.3%) who underwent testing for HIV, 320 (29.2%) were HIV seropositive. The male-to-female ratio of HIV-TB positive outcomes was 1:0.9. Of the 320 HIV-TB co-infected children, 57 (17.8%) were aged <1 year, 86 (26.9%) 1–4 years and 186 (58.1%) 5–14 years; 186/320 (58.1%) began cotrimoxazole preventive therapy (CPT), and 151 (47.2%) were put on antiretroviral treatment (ART). ART uptake was not significantly higher in facilities where HIV-TB services were co-located (P > 0.05).Conclusion: The uptake of CPT and ART was low. There is a need to intensify efforts to improve access to HIV services in Lagos State, Nigeria.     

Barriers for introducing HIV testing among tuberculosis patients in Jogjakarta,Indonesia: a qualitative study

Background  

HIV and HIV-TB co-infection are slowly increasing in Indonesia. WHO recommends HIV testing among TB patients as a key response to the dual HIV-TB epidemic. Concerns over potential negative impacts to TB control and lack of operational clarity have hindered progress. We investigated the barriers and opportunities for introducing HIV testing perceived by TB patients and providers in Jogjakarta, Indonesia.     

Tuberculosis infection among young adults enlisting in the United States Navy

BACKGROUND: Tuberculosis (TB) is a re-emerging infectious disease threat worldwide. To protect the health and readiness of US military personnel, policies exist to screen for and treat latent TB infection at the time of service entrance. RESULTS: of this screening programme have not been recently described. METHODS: Multivariate regression techniques were used to evaluate demographic and medical data associated with TB infection among all young adults entering US Navy enlisted service between 1 October 1997 and 30 September 1998. Results A total of 44,128 adults (ages 17-35, 81% male) were screened for TB during this 12-month period. The prevalence of latent TB infection was 3.5%. Place of birth was very strongly associated with TB infection, with foreign-born recruits eight times more likely to have a reactive tuberculin skin test or history of infection. Those who reported their race as 'Asian/Pacific Island' had 3.8 times the odds of having evidence of TB infection compared with 'Caucasian' recruits, even after adjusting for place of birth. CONCLUSIONS: The prevalence of TB infection among Navy recruits was last reported as 2.5% nearly 10 years ago. The apparent increase to 3.5% in this large cohort is likely due to a concurrent increase in the number of foreign-born recruits, and it serves to underscore the importance of comprehensive screening and treatment of latent TB infections in this population.     

艾滋病与结核混合感染的特点及防治

TB是艾滋病患者最常见的威胁生命的机会性感染之一,两者相互影响,相互促进,大大增加了患者的死亡率。在HIV感染早期,TB的临床表现类似于HIV阴性患者;但在HIV感染的中后期,TB的表现趋于非典型化,加之又缺乏简便有效的诊断方法,诊断相对困难。艾滋病混合感染TB的患者,总的治疗原则同HIV阴性者,DOT和HAART可以显著改善其预后,但抗病毒药物与抗结核药物间副作用的叠加、药代动力学的相互影响及“反常反应”更常见等问题使这一类患者的治疗复杂化。对于高危患者进行有效的预防,有助于减少艾滋病患者混合感染TB的发病率和死亡率。     

Severity of Outcomes Associated to Types of HIV Coinfection with TB and Malaria in a Setting Where the Three Pandemics Overlap

The objectives of this study is to (1) characterize profiles of HIV coinfection with TB and malaria; (2) estimate the severity of outcome associated with each type of coinfection; (3) identify most severe coinfection type, and populations most affected. Data on 1,302 HIV/AIDS patients were collected from hospital record books for 2007 and 2008. Distribution patterns of types of HIV coinfection with TB and malaria were assessed among low and high SES (socioeconomic status) inpatients. Case fatality rate for each type of coinfection was estimated as the ratio of number of deaths associated with a specific type of coinfection over the number of cases, times 100. Case fatality rates were compared among coinfection types and between low and high SES inpatients. Four types of coinfections were identified: single-HIV, HIV-TB, HIV-malaria and HIV-TB-malaria. Single-HIV infection was the most prevalent, and predominant among high SES inpatients; HIV-TB was the second most prevalent, and predominant among low SES inpatients; HIV-malaria and HIV-TB-malaria coinfections were the least prevalent, they were relatively comparable between both SES groups. HIV-TB coinfection was the deadliest type of coinfection, followed by HIV-TB-malaria and HIV-malaria. Single-HIV infection was the least deadly of the four conditions. Aside from HIV-malaria, the proportion of fatalities associated with each coinfection type was higher among low SES inpatients when compared with high SES inpatients. HIV/AIDS treatment and care programs in communities with limited resources and high prevalence of malaria and TB should give priority attention to low socioeconomic status patients coinfected with TB to prevent unnecessary deaths among those living with HIV.     

Acquired rifamycin resistance in persons with advanced HIV disease being treated for active tuberculosis with intermittent rifamycin-based regimens

Rifamycin drugs (i.e., rifampin, rifabutin, and rifapentine) are essential for short-course chemotherapy in persons with active tuberculosis (TB). However, adverse drug-drug interactions complicate the concurrent use of rifamycins and protease inhibitor drugs in persons with active TB who also are infected with human immunodeficiency virus (HIV-TB). CDC has recommended use of rifabutin in place of rifampin in multidrug regimens for the treatment of active TB in HIV-TB because rifabutin can be administered with antiretroviral treatment regimens that include protease inhibitors (1,2). These recommendations included twice-weekly intermittent therapy. Because intermittent rifabutin-based regimens had not been evaluated in clinical trials of HIV-TB, CDC's TB Trials Consortium (TBTC) initiated TBTC Study 23, a single-arm trial of twice-weekly rifabutin-based therapy for treatment of HIV-TB.     

Antiretroviral therapy during tuberculosis treatment and marked reduction in death rate of HIV-infected patients, Thailand

Antiretroviral therapy (ART) is lifesaving in patients with advanced HIV infection, but the magnitude of benefit in HIV-infected patients receiving tuberculosis (TB) treatment remains uncertain, and population-based data from developing countries are limited. We prospectively collected data about HIV-infected TB patients from February 2003 through January 2004 in Ubon-ratchathani, Thailand. During 12 months, HIV was diagnosed in 329 (14%) of 2,342 patients registered for TB treatment. Of patients with known outcomes, death during TB treatment occurred in 5 (7%) of 71 who received ART and 94 (43%) of 219 who did not. Using multivariate analysis, we found a large reduction in the odds of death for patients receiving ART before or during TB treatment (odds ratio, 0.2; 95% confidence interval, 0.1-0.5), adjusting for CD4 count, smear status, co-trimoxazole use, and treatment facility. ART is associated with a substantial reduction in deaths during TB treatment for HIV-infected TB patients in Thailand.     

安徽省某市结核病人中HIV感染状况分析

目的了解安徽省某市结核病人中HIV感染情况,为制定结核病和艾滋病双重感染防治对策提供科学依据。方法对新登记人项的1212例结核病人用酶联免疫法进行HIV初筛试验,初筛阳性者进行免疫印迹法确认试验进行确认,并进行流行病学调查。结果1212例结核病人检出HIV感染者4例（其中死亡1例）,感染率为0．33％,其中健在的3例中,2例男性,1例女性;民工2例,农民1例,平均年龄为（34．00±10．44）岁,传播途径均为性传播。结论结核病人中HIV感染率高于一般人群,应在结核病人群中加强艾滋病的宣传教育和行为干预。     

Mortality among patients with tuberculosis and associations with HIV status --- United States, 1993-2008

Worldwide, tuberculosis (TB) incidence increased from 125 cases per 100,000 population in 1990 to 142 cases per 100,000 population in 2004, primarily because of the human immunodeficiency virus (HIV) epidemic. Persons with HIV are at increased risk for TB disease, and those with TB have a high risk for death. This is documented most clearly in resource-limited settings, where limited access to antiretroviral therapy (ART) and other health-care services contribute to the elevated mortality. The impact of HIV on patients with TB is less clear in resource-rich nations such as the United States. To understand the impact of HIV on the risk for death during TB treatment in the United States, data were analyzed for all culture-positive patients with TB from 1993 to 2008, and the proportion that died was determined and stratified by HIV test result. Mortality data were restricted to patients reported before 2007. The proportion of all patients with TB who died during TB treatment decreased from 2,445 of 13,629 (18%) in 1993 to 682 of 7,578 (9%) in 2006. Among patients with TB and HIV, 950 of 2,337 (41%) died during treatment in 1993; this proportion declined to 131 of 663 (20%) in 2006. The proportion of patients with TB and HIV who received their TB diagnosis postmortem dropped from 191 of 2,927 (7%) in 1993 to 32 of 768 (4%) in 2006; 624 of 10,468 (6%) persons with TB and unknown HIV status received their TB diagnosis postmortem in 1993, and this proportion did not decline. Further reductions in mortality can be achieved by enhanced TB/HIV program collaboration and service integration.     

CD209 gene polymorphisms in South Indian HIV and HIV-TB patients

Dendritic-cell-specific intercellular adhesion molecule-3 (ICAM-3)-grabbing non-integrin (DC-SIGN), a pattern recognition receptor, is associated with immune functions and is also exploited by HIV-1 and Mycobacterium tuberculosis as a part of their immune evasion strategy. In the present study we investigated whether variants in the DC-SIGN encoding CD209 gene are associated with susceptibility to or protection against HIV-1 infection as well as development of tuberculosis (TB) among HIV-1 infected south Indian patients. CD209 gene variants in the promoter region (?336 and ?139), in the intron and 3′-untranslated regions (In2+11 and 2281) were studied using polymerase chain reaction-based genotyping methods in 131 HIV patients without TB (HIV+TB?) and 107 HIV patients with TB (HIV+TB+), 107 HIV negative pulmonary TB patients (HIV?PTB+) and 157 healthy controls. Results revealed a decreased frequency of ?336 G/G genotype among all HIV patients compared to healthy controls and ?336 G/G genotype was not observed among HIV+TB? individuals (p = 0.005; odds ratio (OR) 0 (95% confidence intervals (CI) 0–0.46); Peto's odds ratio 0.149 (95% CI 0.045–0.50)). Among HIV+ patients, those with TB had a significantly increased frequency of ?336 G/G genotype (p = 0.003; OR undefined; Peto's odds ratio 9.8 (95% CI 2.2–44.3)) compared to those without TB. Other polymorphisms were not significantly different between the various study groups. The results suggest that ?336 G/G genotype while associated with protection against HIV-1 infection the same genotype is also associated with susceptibility to HIV-TB among south Indians.     

Control of tuberculosis in relation to the HIV/AIDS epidemic. Work Group at the Secretariat of the National Plan on AIDS

On April 7, 1999, the Monographic Meeting on HIV Infection and Tuberculosis was held at the Secretariat of the National AIDS Plan for the purpose of setting out certain clinical and health care policy recommendations concerning the control of tuberculosis (TB) with regard to the HIV infection epidemic, those in attendance being listed in Appendix 1. This meeting was organized into a number of presentations of papers (Appendix 2) grouped into four subject areas, which were followed by the pertinent debates. These four areas were as follows: 1. Epidemiology of the Dual HIV-TB Infection. 2. Treatments to Combat TB. 3. TB Prevention. 4. Health Care/TB Control Programs. The papers presented regarding a review of current literature focused on the search for scientific evidence with regard to treating and preventing TB among HIV-positive patients. The rest of the papers presented were: 1) regarding epidemiological topics 2) regarding results of different TB control programs and 3) regarding the analysis of the international and national recommendations concerning TB treatments and prevent among HIV-positive patients. Following the meeting, this report has been prepared as a summary thereof and was revised by all those who were in attendance at the meeting, the goal of which is that of setting out some recommendations for health care control and clinical handling of the dual Mycobacterium tuberculosis and HIV infection. This report provides no systematic or sufficiently detailed review of the different topics analyzed, therefore opting with regard to the bibliography to recommend a number of brief articles and reference books as a general source for further consultation. In this report, the term of "dual" TB-HIV infection is used generally and, in others the more specific "dual TB-AIDS disease", depending upon the presence of infection or disease caused by M. Tuberculosis and also AIDS, therefore, in the latter case.     

The rate of TB-HIV co-infection depends on the prevalence of HIV infection in a community

Background  

A complex interaction exists between tuberculosis (TB) and human immunodeficiency virus (HIV) infection at an individual and community level. Limited knowledge about the rate of HIV infection in TB patients and the general population compromises the planning, resource allocation and prevention and control activities. The aim of this study was to determine the rate of HIV infection in TB patients and its correlation with the rate HIV infection in pregnant women attending antenatal care (ANC) in Southern Ethiopia.     

Prediction of adult-onset smoking initiation among U.S. Air force recruits using the pierce susceptibility questionnaire

BACKGROUND: At one time, it was expected that if an individual reached young adulthood without smoking, his/her risk for initiation was minimal. However, recent data suggest that smoking initiation among young adults may be increasing. One particularly vulnerable population of young adults for smoking initiation is military recruits. This study examined whether a modified version of the Pierce Susceptibility Questionnaire (PSQ) might be useful for identifying military recruits who are vulnerable for the initiation of tobacco use. METHODS: Active duty recruits entering the U.S. Air Force over a 1-year period (n=31,107) were assessed upon entry into basic military training (BMT), and a subsample was also assessed at 12 months following training. RESULTS: The modified PSQ predicted initiation of cigarette use for all categories of baseline smokers (never, experimenters, former smokers, and regular users). The likelihood of initiating smoking after BMT was substantially higher among those identified as susceptible than among those identified as not susceptible. CONCLUSIONS: It is likely that the PSQ would prove to be a valuable tool in attempts to reduce tobacco use in the military. The predictive abilities of the measure could be used to target intervention and prevention efforts towards those most at risk.     

荧光定量PCR对血及痰培养物中结核分枝杆菌DNA的检测

目的 评价荧光定量PCR(FQ-PCR)检测血及痰培养物中结核分枝杆菌的临床价值.方法 81例临床诊断为结核病的痰涂片阴性患者中,单纯肺结核40例(肺结核组),合并HIV感染的患者41例(合并感染组).患者的血、痰样本分别进行结核分枝杆菌及其L型培养,采用FQ-PCR技术检测血及痰培养液中结核分枝杆菌DNA.结果 肺结核组结核分枝杆菌痰培养FQ-PCR阳性率为54.1%(20/37);血培养阳性率为27.5%(11/40),血培养FQ-PCR阳性率为22.5%(9/40),血培养及其FQ-PCR总阳性率42.5%(17/40).合并感染组10例痰样本培养后2例FQ-PCR阳性;血培养阳性率为7.3%(3/41),血培养FQ-PCR阳性率为17.1%(7/41).合并感染组血培养物FQ-PCR阳性率(17.1%)与肺结核组(22.5%)相比,差异无统计学意义(P>0.05).两组痰与血培养物FQ-PCR总阳性率分别为65.0%(26/40)和22.0%(9/41),差异有统计学意义(χ2=15.305,P<0.01).结论 痰或血培养物FQ-PCR检测有助于提高结核或结核合并艾滋病患者的诊断,同时显著提高了痰涂片阴性肺结核患者的诊断.     

2016—2020年贵州省TB/HIV双重感染的时空分布特征

目的 分析2016—2020年贵州省HIV/AIDS、结核病(TB)及TB/HIV双重感染报告病例的时间及空间分布特征、相关性及发病情况的“热点”地区,为我省HIV/AIDS、TB及TB/HIV双重感染的重点地区防控及医疗资源合理分配提供一定参考依据。方法 采用经国家疾控中心统一制定的“TB/HIV双重感染防治工作年度报表”进行数据收集,应用ArcGIS 10.2软件进行全局空间自相关和局部空间自相关分析。结果 2016—2020年HIV/AIDS双重感染登记报告率呈波动上升趋势(_趋势=109.953,P<0.001); HIV/AIDS、TB、TB/HIV双重感染报告病例数历年环比增长率均呈负增长趋势。全局空间自相关分析显示,5年全省9个市州TB/HIV双重感染报告发病率只有2018年存在空间负相关,为随机分布; 全省88个县区HIV/AIDS和TB报告发病率均存在空间正相关,为聚集性分布。局部空间自相关分析显示,5年来贵州省HIV/AIDS热点区域主要以西南部4个县区和南部3个县区为主,并向周围地区辐射; 结核病TB病例报告热点地区以西南部4个县区为主,并且不断向外扩展; TB/HIV双重感染病例报告热点地区较不稳定。结论 贵州省HIV/AIDS、TB及TB/HIV双重感染报告病例近年虽然有所减少,但依然存在疾病流行热点区域,建议加强对高发地区的监管力度和对重点人群的主动发现工作,同时完善诊疗和保障水平,关注周边地区疾病发生情况,避免热点地区不断向外辐射。     

The burden and outcomes of childhood tuberculosis in Cotonou,Benin

Setting:

The National Tuberculosis Programme (NTP) and the paediatric ward of the General Hospital (GH), Cotonou, Benin.

Objective:

To describe the burden of tuberculosis (TB), characteristics and outcomes among children treated in Cotonou from 2009 to 2011.

Design:

Cross-sectional cohort study consisting of a retrospective record review of all children with TB aged <15 years.

Results:

From 2009 to 2011, 182 children with TB were diagnosed and treated (4.5% of total cases), 153 (84%) by the NTP and 29 (16%) by the GH; the latter were not notified to the NTP. The incidence rate of notified TB cases was between 8 and 13 per 100 000 population, and was higher in children aged >5 years. Of 167 children tested, 29% were HIV-positive. Treatment success was 72% overall, with success rates of 86%, 62% and 74%, respectively, among sputum smear-positive, sputum smear-negative and extra-pulmonary patients. Treatment success rates were lower in children with sputum smear-negative TB (62%) and those with HIV infection (58%).

Conclusion:

The number of children being treated for TB is low, and younger children in particular are underdiagnosed. There is a need to improve the diagnosis of childhood TB, especially among younger children, and to improve treatment outcomes among HIV-TB infected children, with better follow-up and monitoring.     

Prevalence of tuberculous infection and incidence of tuberculosis: a re-assessment of the Styblo rule

OBJECTIVE: To evaluate the validity of the fixed mathematical relationship between the annual risk of tuberculous infection (ARTI), the prevalence of smear-positive tuberculosis (TB) and the incidence of smear-positive TB specified as the Styblo rule, which TB control programmes use to estimate the incidence of TB disease at a population level and the case detection rate. METHODS: Population-based tuberculin surveys and surveys on prevalence of smear-positive TB since 1975 were identified through a literature search. For these surveys, the ratio between the number of tuberculous infections (based on ARTI estimates) and the number of smear-positive TB cases was calculated and compared to the ratio of 8 to 12 tuberculous infections per prevalent smear- positive TB case as part of the Styblo rule. FINDINGS: Three countries had national population-based data on both ARTI and prevalence of smear-positive TB for more than one point in time. In China the ratio ranged from 3.4 to 5.8, in the Philippines from 2.6 to 4.4, and in the Republic of Korea, from 3.2 to 4.7. All ratios were markedly lower than the ratio that is part of the Styblo rule. CONCLUSION: According to recent country data, there are typically fewer than 8 to 12 tuberculous infections per prevalent smear-positive TB case, and it remains unclear whether this ratio varies significantly among countries. The decrease in the ratio compared to the Styblo rule probably relates to improvements in the prompt treatment of TB disease (by national TB programmes). A change in the number of tuberculous infections per prevalent smear-positive TB case in population-based surveys makes the assumed fixed mathematical relationship between ARTI and incidence of smear-positive TB no longer valid.     

Anemia Burden,Types and Associated Risk Factors among Kenyan Human Immunodeficiency Virus-1 and Mycobacterium Tuberculosis Co-infected Injection Substance Users

BackgroundAlthough injection substance users and individuals co-infected with Human Immunodeficiency Virus-1 and Mycobacterium tuberculosis suffer marked hematologic derangements, the rates, levels, morphologic types and associated risk factors of anemia among Human immunodeficiency virus and Mycobacterium tuberculosis coinfected injection substance users has not been reported in Kenya.MethodsThis cross-sectional study determined anemia rates, levels and morphologic types. Anemia was associated with clinical markers of disease- underweight, immunosuppression and viral load. Complete blood count, CD4 T-cell enumeration and viral load were determined via standard laboratory methods.ResultsAll injection substance users had higher rates of anaemia (HIV+TB+ ISUs, 79.3%; HIV-TB+ISUs, 70.0%; HIV+TB- ISUs, 56.6% and HIV-TB- ISUs, 56.2%) relative to non-ISUs (16.6%; P<0.05). A significant proportion of HIV+TB+ISUs (47.8%) developed severe anemia than other clinical groups. The commonest morphologic type of anemia in HIV+TB+ISUs was microcytic hypochromic (43.5%) followed by normocytic hypochromic (17.4%) relative to the other clinical groups. HIV+TB+ ISUs with CD4 T-cells <200/uL (OR: 2.94, 95% CI: 1.41–6.13, P=0.004) and CD4 Tcells of 200–349/uL (OR: 3.24, 95% CI: 1.66–6.31, P=0.001) associated with higher odds of developing anemia.ConclusionThis study revealed that severe anemia and microcytic hypochromic anemia are the most common erythrocytic sequelae among Human Immunodeficiency Virus-1 and Mycobacterium tuberculosis co-infected ISUs. Those with CD4 T-cells < 350/uL are utmost expected to develop anemia.     

Emergence of Increased Resistance and Extensively Drug-Resistant Tuberculosis Despite Treatment Adherence, South Africa

We investigated the emergence and evolution of drug-resistant tuberculosis (TB) in an HIV co-infected population at a South African gold mine with a well-functioning TB control program. Of 128 patients with drug-resistant TB diagnosed during January 2003–November 2005, a total of 77 had multidrug-resistant (MDR) TB, 26 had pre–extensively drug-resistant TB (XDR TB), and 5 had XDR TB. Genotyping suggested ongoing transmission of drug-resistant TB, and contact tracing among case-patients in the largest cluster demonstrated multiple possible points of contact. Phylogenetic analysis demonstrated stepwise evolution of drug resistance, despite stringent treatment adherence. These findings suggested that existing TB control measures were inadequate to control the spread of drug-resistant TB in this HIV co-infected population. Diagnosis delay and inappropriate therapy facilitated disease transmission and drug-resistance. These data call for improved infection control measures, implementation of rapid diagnostics, enhanced active screening strategies, and pharmacokinetic studies to determine optimal dosages and treatment regimens.     

Space-time confounding adjusted determinants of child HIV/TB mortality for large zero-inflated data in rural South Africa

South Africa is experiencing a major burden of HIV/TB. We used longitudinal data from the Agincourt sub-district in rural northeast South Africa over the years 2000 to 2005. A total of 187 HIV/TB deaths were observed among 16,844 children aged 1-5 years coming from 8,863 households. In this paper we used Bayesian models to assess risk factors for child HIV/TB mortality taking into account the presence of spatial correlation. Bayesian zero inflated spatiotemporal models were able to detect hidden patterns within the data. Our main finding was that maternal orphans experienced a threefold greater risk of HIV/TB death compared to those with living mothers (AHR=2.93, 95% CI[1.29;6.93]). Risk factor analyses which adjust for person, place and time provide evidence for policy makers that includes a spatial distribution of risk. Child survival is dependent on the mother's survival; hence programs that promote maternal survival are critical.