Recurrent culture-confirmed tuberculosis in human immunodeficiency virus-infected children

Abstract

Introduction: Recurrent tuberculosis (TB) is more common among human immunodeficiency virus (HIV)-infected than HIV-uninfected adults. There are limited data regarding recurrence of TB in children.

Objective: To determine the occurrence of recurrent TB in HIV-infected children with culture-confirmed tuberculosis.

Methods: HIV-infected children with culture-confirmed TB, identified from 1992 to 2000, were followed until February 2004 for further confirmed TB episodes 6 months or more after completion of previous antituberculosis therapy. Clinical data and results of special investigations were recorded. Restriction fragment length polymorphism (RFLP) analysis of Mycobacterium tuberculosis isolates was done when possible.

Results: Of 87 children, 9 had a second episode; 2 of these had a third episode of confirmed TB. Adherence to treatment was good in 8; 2 experienced hepatotoxicity, and regimens were changed. Chest radiographs were normal in only 2 children after first treatment completion. Bacteriologic cure was documented in 7 episodes before recurrence. RFLP analysis showed 3 children infected with the same strain (relapse) and 1 child with a different strain between episodes 1 and 3 (reinfection). Two further cases had reinfection based on epidemiologic data and drug susceptibility test results. Full comparison of strains by RFLP was not possible because of the unavailability of isolates of the first episode in 5 cases.

Conclusion: Recurrent TB in HIV-infected children is common in a high burden TB setting. Both relapse and reinfection occur.