Detection, diagnosis and clinical tuberculosis in children with hiv infection

Abstract

The problem of combination of tuberculosis (TB) and HIV remains relevant. Majority of HIV patients are young adults, 90% of which are women of childbearing age, thereby increasing the perinatal HIV transmission rate. In 2014 in Saint Petersburg, >5,000 children with perinatal contact HIV were reported and >300 children were confirmed with HIV infection. We present a comparative analysis of the case histories of 20 children with TB-HIV and 30 with tuberculosis without HIV infection. The analysis identified several cases of delayed diagnosis. In >50% of the cases, the diagnosis of HIV infection was confirmed after 1 year. Four children with HIV infection were diagnosed at school age and connected to suspected cases of tuberculosis. The clinical detection of TB occurs more commonly in children with HIV infection than in those without HIV infection (25% and 5%, respectively). In both groups, tuberculosis of the intrathoracic lymph nodes was predominantly observed; however, generalized forms of TB were also diagnosed in the group with co-infection (25% of the cases). HIV patients often have decreased body mass, low-grade fever, lymphadenopathy, and anemia. Hepatosplenomegaly was equally observed in both groups. More than one third (35%) of patients with co-infection had negative sensitivity to tuberculin, and Diaskintest was positive in 50% of the cases. The prevalence and severity of TB in children with HIV infection correlates with the severity of immunosuppression.