Children living with HIV prone to recurrent TB

The rate of tuberculosis (TB) recurrence in children is high, particularly among those living with HIV (CLHIV), suggests a recent study.

This prospective, observational cohort study involved children aged 0‒13 years who presented with presumptive pulmonary TB in Cape Town, South Africa from March 2012 to March 2017. Recurrent TB was characterized by more than one episode of TB treatment (microbiologically confirmed and unconfirmed).

A total of 620 children with presumptive pulmonary TB were enrolled, of whom 608 (median age 16.7 months, 53.3 percent male, 11.8 percent CLHIV) were assessed for TB recurrence.

Almost half of the children had a TB diagnosis (n=297, 48.8 percent). Of these, 26 had previously received TB treatment, leading to a recurrence prevalence of 8.8 percent: 22 (84.6 percent) had one and four (15.4 percent) had two prior TB treatment episodes.

Children with recurrent TB had a median age of 47.5 months at the current episode. Nineteen of 26 (73.1 percent) were CLHIV, and 12 of 19 (63.2 percent) had been treated with antiretroviral therapy (ART) for a median of 43.1 months. These 12 patients had been on ART for >6 months.

Of the nine children on ART with available viral load (VL) data, none had viral suppression (median VL, 22,983 copies/ml).

In addition, three of the 26 children (11.6 percent) had microbiologically confirmed TB at two episodes, and four (15.4 percent) received drug-resistant TB treatment at recurrence.