Incidence of tuberculosis in human immunodeficiency virus-infected children in India: Is there a role of isoniazid preventive therapy?

Abstract

Aim:

The aim of this study is to determine the role of isoniazid preventive therapy (IPT) in human immunodeficiency virus (HIV)-infected children in India.

Materials and Methods:

Factors associated with the development of tuberculosis (TB) in 81 HIV-infected children were analyzed.

Results:

The mean age of presentation was 6.36 ± 3.67 years. According to the CDC classification, 4.9% of patients were in Class N, 11.1% were in Class A, 56.8% were in Class B, and 27.2% were in Class C at presentation. TB at presentation was more common in children in CDC Class B and C ( P = 0.026). Gender, CD4 count, TB contact, prior TB, and ART status did not have any effect on the development of TB. Children up to 3 years of age developed TB after 6.23 ± 14.07 months after presentation, those between 3 and 6 years developed TB after 14.6 ± 23.27 months, those between 6 and 9 years developed TB after 6.54 ± 21.23 months, those between 9 and 12 years developed TB 40.2 ± 35.98 months after presentation ( P = 0.042). Eight patients (16.7%) had multidrug-resistant (MDR) TB and 1 patient (2.08%) had extensively drug-resistant TB.

Conclusion:

Younger children are more likely to develop TB within a year of presentation whereas those who were near the adolescent age group were more likely to develop TB after 3 years of diagnosis of HIV. Thus, role of IPT in adolescents for 3 years at the time of diagnosis may not be useful as they tend to develop TB later on whereas IPT may be useful in the younger age group. With high incidence of MDR-TB, role of IPT in HIV-infected children in India needs to be re-assessed.