Abstract
Purpose of the study. To establish risk factors for tuberculosis (TB) in children perinatally exposed to HIV and HIV-infected for the development of corrective measures.Materials and methods. Outpatient records (form No. 025/y) of 216 children perinatally exposed to HIV and 121 children with HIV infection and their parents (281 individuals) were analyzed. The control group consisted of 100 healthy children. Epidemiological (descriptive, evaluative and analytical) and statistical research methods were used in the study.Results. The likelihood of contact with a patient with an active form of TB was significantly higher in perinatally exposed to HIV and HIV-infected children compared to children in the control group (p 0.001). The risk of TB in HIV-exposed children was 5.3 times higher in foci where both parents were HIV-infected than in foci formed by discordant couples (RR = 5.3; 95% CI 1.7–21.7). Children in study groups who were not vaccinated with BCG had the highest risk of TB compared to children in the control group (RR = 1.9; 95% CI 1.6–2.2).Conclusion. Risk factors for TB in children perinatally exposed to HIV are untimely vaccination against TB or its absence and living in the foci where both parents are HIV-infected. The predictors of the development of TB in HIV-infected children are household contacts with TB patient , late diagnosis of HIV infection, and late prescription of highly active antiretroviral therapy after the formation of severe immunosuppression.
Highlights
To establish risk factors for tuberculosis (TB) in children perinatally exposed to HIV and HIV-infected for the development of corrective measures
The risk of TB in HIV-exposed children was 5.3 times higher in foci where both parents were HIV-infected than in foci formed by discordant couples (RR = 5.3; 95% CI 1.7–21.7)
Children in study groups who were not vaccinated with BCG had the highest risk of TB compared to children in the control group (RR = 1.9; 95% CI 1.6–2.2)
Summary
В проспективном когортном исследовании с целью определения факторов риска заболевания ТБ были проанализированы амбулаторные карты (форма No 025у) 216 детей с перинатальным контактом по ВИЧ с нереализованной трансмиссией вируса и 121 ребенка с ВИЧ-инфекцией, в том числе 61 с коинфекцией (ВИЧ + ТБ), состоявших на диспансерном учёте в клинико-диагностическом отделении ГБУЗ СО «ОЦ СПИД». Средний возраст детей в момент исследования в группе экспонированных ВИЧ составлял 3,9 ± 2,7 года (95% доверительный интервал (ДИ) 9,1–1,4), ВИЧ-инфицированных — 8,8 ± 0,5 (95% ДИ 19,7–1,4) и контрольной группе — 2,4 ± 0,3 года (95% ДИ 2,9–1,8). Для оценки иммунного статуса детей с ВИЧ-инфекцией определяли количество CD4-лимфоцитов в момент постановки клинического диагноза. Факторы риска развития ТБ у ВИЧ-инфицированных детей определяли отношением шансов в пределах 95% ДИ. У детей, перинатально экспонированных ВИЧ, при помощи однофакторного анализа определяли относительный риск развития туберкулеза (RR). В группе перинатально экспонированных ВИЧ 73,8% детей родились в полных семьях, в том числе более чем в половине из них оба родителя были ВИЧ-положительными В семьях, где оба родителя были ВИЧ-инфицированными, активную форму ТБ диагностировали у 60% родителей, а в очагах с одним ВИЧ-инфицированным — у 50%.
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