Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 8  |  Issue : 5  |  Page : 590-593  

Tuberculosis in children of HIV-infected parents


1 Department of Community Medicine, Smt. Kashibai Navale Medical College, Narhe, Pune, Maharashtra, India
2 Department of Community Medicine, MAEER's MIMER Medical College, Talegaon, Pune, Maharashtra, India

Date of Web Publication10-Sep-2015

Correspondence Address:
Dhrubajyoti J Debnath
Department of Community Medicine, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune - 411 041, Maharashtra
India
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Source of Support: Nil., Conflict of Interest: None declared.


DOI: 10.4103/0975-2870.164973

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  Abstract 

Context: Tuberculosis (TB) in children of human immunodeficiency virus (HIV) infected parents is of concern.Aims: To study the proportion of children of HIV-infected parents who suffered from TB and to study some of the associated risk factors.Settings and Design: Cross-sectional study design.Materials and Methods: Ethical approval and informed consent were taken. A total of 385 children of HIV-infected parents were studied for TB.Statistical Analysis Used: Proportion, Chi-square test.Results: In the study, it was found that there were 191 (49.6%) HIV-positive children, 136 (35.6%) HIV negative children and in 58 (14.8%) children, the HIV status was unknown. 53 (13.8%) out of 385 children had suffered from TB. Among these 50 children were HIV positive and three children were HIV negative.Conclusions: The only significant risk factor for TB in children of HIV-infected parents was HIV infection in children. Therefore, it is recommended that the HIV positive parents should be counseled to get their children tested at an integrated counseling and testing center because it was found that 15% of children had unknown HIV status. Once it is known that the child has HIV infection, effective measures should be taken to prevent TB since they are significantly at an increased risk of TB.

Keywords: Children, human immunodeficiency virus, prevention, tuberculosis


How to cite this article:
Debnath DJ, Javadekar SS. Tuberculosis in children of HIV-infected parents. Med J DY Patil Univ 2015;8:590-3

How to cite this URL:
Debnath DJ, Javadekar SS. Tuberculosis in children of HIV-infected parents. Med J DY Patil Univ [serial online] 2015 [cited 2019 Dec 15];8:590-3. Available from: http://www.mjdrdypu.org/text.asp?2015/8/5/590/164973


  Introduction Top


Tuberculosis (TB) is among the top 10 causes of death among children worldwide. In low-burden countries, childhood TB constitutes ∼5% of the TB caseload, as compared with 20-40% in high-burden countries.[1],[2],[3] Millennium development goal six focuses on turning around the TB, human immunodeficiency virus (HIV), and malaria epidemics. At least half a million children become ill with TB each year.[4]

India and China accounted for 40% of the world's notified cases of TB in 2010, Africa for a further 24% and the 22 high-TB burden countries for 82%.[5] A syndemic is defined as the convergence of two or more diseases that act synergistically to magnify the burden of disease. HIV is the strongest risk factor for developing TB in those with latent or new Mycobacterium TB infection. The risk of developing TB is between 20 and 37 times greater in people living with HIV than among those who do not have HIV infection. The syndemic interaction between the HIV and TB epidemics has had deadly consequences around the world.[6],[7]

Keeping this in mind, the study was carried out with the objective to study the proportion of children of the HIV-infected parents who suffered from TB and to study some of the associated risk factors.


  Materials and Methods Top


This was a cross-sectional study. Ethical approval was taken from the Institutional Ethics Committee of B. J. Medical College and Sassoon General Hospitals, Pune, India in the year 2007 which was prior to the commencement of the study. Informed consent was taken from the parent/guardian of the child before the study. Period of data collection was from July 2008 to June 2009.

Diagnosis of HIV infection was as per the National AIDS Control Organization (National AIDS Control Organization) guidelines.[8]

Sample size was calculated using Epi Info™ software assuming expected frequency of 50% in children of parents infected with HIV/AIDS, confidence limits of 5%, design effect as 1, confidence level of 95%. The sample size calculated was 384. Two nongovernmental organizations (NGOs) and three orphanages in the state of Maharashtra, India co-operated for the study. The study population consisted of children (<15 years of age) whose either or both parent(s) were infected by HIV and enrolled with these two NGOs and residing in these three orphanages in state of Maharashtra, India. A total of 385 children could be studied.

The study was done with the help of pretested semi-structured questionnaire.

Of 385 children, 226 children were residing in the community and 159 children were residing in orphanages. These children were studied for the common opportunistic infection TB.

Data management and analysis

The data obtained were entered in a Microsoft Office Excel sheet. To ensure confidentiality of the study subjects, a password was given to the excel sheet. The entered data were cleaned and then analyzed using Epi-Info software version 3.5.3, Epi-Info 7 (www. OpenEpi.com, OpenEpi is free and open source software for epidemiologic statistics. OpenEpi development was supported in part by a grant from the Bill and Melinda Gates Foundation to Emory University, Rollins School of Public Health). Statistics used was calculation of proportion, Chi-square test.P< 0.05 was taken as statistically significant.


  Results Top


In the study, it was found that there were 191 (49.6%) HIV-positive children, 136 (35.6%) HIV negative children and in 58 (14.8%) children, the HIV status was unknown.

As seen from [Table 1], 53 (13.8%) out of 385 children had suffered from TB.
Table 1: HIV and TB

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As seen in [Table 2], after excluding the 58 children whose HIV status was not known, it was found that out of 191 HIV-positive children, 50 (26.2%) children had suffered from TB and out of 136 HIV-negative children, only 3 (2.2%) children had suffered from TB and this difference was statistically highly significant.
Table 2: Known HIV status and TB

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As seen in [Table 3], 2 (5.6%) children out of 36 under-five children had suffered from TB. 24 (15.4%) children out of 156 children in age-group 60-119 months had suffered from TB. 27 (14%) children out of 193 children in the age-group 120-179 months had suffered from TB. There was no statistically significant difference between age of the child and TB.
Table 3: Age of child and TB

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As seen in [Table 4], of 208 male children, 35 (16.8%) had suffered from TB while 173 (83.2%) did not suffer from TB. Of 177 female children, 18 (10.2%) had suffered from TB while 159 (89.8%) did not suffer from TB. This difference was statistically not significant.
Table 4: Gender of child and TB

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As seen in [Table 5], of 159 children residing in orphanage, 43 (27%) had suffered from TB and out of 226 children residing in community, 10 (4.4%) had suffered from TB and the difference was statistically highly significant.
Table 5: HIV status and TB

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As seen in [Table 6], of 159 HIV positive children residing in orphanage, 43 (27%) had suffered from TB whereas 7 (21.9%) out of 32 HIV positive children residing in community had suffered from TB, but the difference was not statistically significant.
Table 6: HIV positive children and TB

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Two hundred and twenty-six children residing in the community belonged to 114 couples. As seen in [Table 7], of 114 couples, 17 (14.9%) wives were HIV negative, 95 (83.3%) wives were HIV positive, and 2 (1.8%) wives had HIV status as unknown. Of 114 couples, 3 (2.6%) husbands were HIV negative, 106 (93%) husbands were HIV positive, and 5 (4.4%) husbands had HIV status as unknown.
Table 7: HIV status of the partners in 114 couples in community

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As seen in [Table 8], mothers of 38 (16.8%) children were HIV negative, mothers of 182 (80.5%) children were HIV positive, and mothers of 6 (2.7%) children did not know their HIV status. Fathers of 7 (3.1%) children were HIV negative, fathers of 209 (92.5%) children were HIV positive, and fathers of 10 (4.4%) children did not know their HIV status.
Table 8: Distribution of HIV status of the parents of 226 children residing in the community

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  Discussion Top


As seen from [Table 2], 26.2% HIV-positive children had suffered from TB while only 2.2% HIV negative children had suffered from TB and this difference was statistically highly significant. HIV-associated TB contributes substantially to the burden of TB-associated morbidity and mortality.[7],[9] In a small study reported from Mumbai,[10] 18% of children with disseminated TB were HIV positive. Reported co-infection of HIV-TB in some Indian studies was 16-68%.[11],[12],[13] In a study by Jose et al. in the Southern part of India, 19 out of 100 HIV-positive children had pulmonary TB.[14]

As seen in [Table 3], the largest proportion (15.4%) of children who suffered from TB were in the age-group of 60-119 months followed by 14% children in the age-group 120-179 months and only 5.6% children in under-five age group. Of 53 TB cases, 2 (3.7%) children were <5 years of age, 24 (45.3%) children were in the age-group 60-119 months, and 27 (51%) were in the age-group 120-179 months. Similar findings were found by Satyanarayana et al. who conducted cross-sectional study in Delhi and reported that majority of childhood TB were aged 5 years and above with just 11.4% being in the age-group 0-5 years.[15]

As seen from [Table 4], a higher proportion (16.8%) of male children suffered from TB whereas 10.2% of female children suffered from TB, but this difference was not statistically significant.

As seen from [Table 5], a large proportion of children residing in an orphanage had suffered from TB as compared to children residing in the community and the difference was statistically highly significant. But the difference may be due to the reason that the orphanage was home to HIV positive children. All the 159 children residing in an orphanage were HIV positive whereas 32 children (out of 226 children) residing in the community were known to be HIV positive. Further analysis of only HIV positive children and TB in [Table 6] showed no statistically significant difference between those residing in orphanage and community.

As seen from [Table 7], of 114 couples, HIV concordant couples were 87 that is, both the partners, that is, husbands and wives were HIV positive. HIV discordant couples were 20 that is, either only husband or only wife was HIV positive. In 7 couples, either husband or the wife had unknown HIV status and hence could not be classified as concordant/discordant.

In our study, the only significant risk factor associated with TB was HIV infection. In about 15% of children, the HIV status was not known to the parents because they had not tested their children for HIV infection. Therefore, it is recommended that the HIV positive parent(s) should be counseled to get their children tested at an Integrated Counselling and Testing Centre because it was found that 15% of children had unknown HIV status. Once it is known that the child has HIV infection, effective measures should be taken to prevent TB since they are at an increased risk of TB.



 
  References Top

1.
Marais BJ, Hesseling AC, Gie RP, Schaaf HS, Beyers N. The burden of childhood tuberculosis and the accuracy of community-based surveillance data. Int J Tuberc Lung Dis 2006;10:259-63.  Back to cited text no. 1
    
2.
World Health Organization. A Research Agenda for Childhood Tuberculosis: Improving the Management of Childhood Tuberculosis within National Tuberculosis Programmes: Research Priorities Based on a Literature Review. Geneva: World Health Organization; 2007.  Back to cited text no. 2
    
3.
Swaminathan S, Rekha B. Pediatric tuberculosis: Global overview and challenges. Clin Infect Dis 2010;50 Suppl 3:S184-94.  Back to cited text no. 3
    
4.
World Health Organization Combating tuberculosis in children. Available from: http://www.who.int/tb/challenges/childtb_factsheet.pdf. [Last accessed on 2013 Oct 16].  Back to cited text no. 4
    
5.
WHO Report. Global Tuberculosis Control; 2011. Available from: http://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf. [Last accessed on 2013 Oct 17].  Back to cited text no. 5
    
6.
Guidelines for Intensified Tuberculosis Case Finding and Isoniazid Preventive Therapy for People Living with HIV in Resource-Constrained Settings. World Health Organization, 2011. Available from: http://www.whqlibdoc.who.int/publications/2011/9789241500708_eng.pdf. [Last accessed on 2013 Oct 16].  Back to cited text no. 6
    
7.
Kwan CK, Ernst JD. HIV and tuberculosis: A deadly human syndemic. Clin Microbiol Rev 2011;24:351-76.  Back to cited text no. 7
    
8.
Ministry of Health and Family Welfare, Government of India, NACO. Guidelines for HIV Care and Treatment in Infants and Children November 2006. Available from: http://www.nacoonline.org/upload/Policies%20and%20Guidelines/4-%20Guidelines%20for%20HIV%20care%20and%20treatment%20in%20Infants%20and%20children.pdf. [Last accessed on 2012 Dec 18].  Back to cited text no. 8
    
9.
Kabra SK, Lodha R, Seth V. Some current concepts on childhood tuberculosis. Indian J Med Res 2004;120:387-97.  Back to cited text no. 9
    
10.
Merchant RH, Shroff RC. HIV seroprevalence in disseminated tuberculosis and chronic diarrhea. Indian Pediatr 1998;35:883-7.  Back to cited text no. 10
    
11.
Lodha R, Singhal T, Jain Y, Kabra SK, Seth P, Seth V. Pediatric HIV infection in a tertiary care center in North India: Early impressions. Indian Pediatr 2000;37:982-6.  Back to cited text no. 11
    
12.
Merchant RH, Oswal JS, Bhagwat RV, Karkare J. Clinical profile of HIV infection. Indian Pediatr 2001;38:239-46.  Back to cited text no. 12
    
13.
Dhurat R, Manglani M, Sharma R, Shah NK. Clinical spectrum of HIV infection. Indian Pediatr 2000;37:831-6.  Back to cited text no. 13
    
14.
Jose R, Chandra S, Puttabuddi JH, Vellappally S, Al Khuraif AA, Halawany HS, et al. Prevalence of oral and systemic manifestations in pediatric HIV cohorts with and without drug therapy. Curr HIV Res 2013;11:498-505.  Back to cited text no. 14
[PUBMED]    
15.
Satyanarayana S, Shivashankar R, Vashist RP, Chauhan LS, Chadha SS, Dewan PK, et al. Characteristics and programme-defined treatment outcomes among childhood tuberculosis (TB) patients under the national TB programme in Delhi. PLoS One 2010;5:e13338.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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