Tuberculosis during early antiretroviral-induced immune reconstitution in HIV-infected children

Abstract

Setting: Referral paediatric hospital, Cape Town, South Africa.

Objective: To describe the clinical manifestations of Mycobacterium tuberculosis (TB) associated disease in human immunodeficiency virus (HIV) infected children during early antiretroviral-induced immune reconstitution.

Design: Case series.

Results: Eleven patients with probable or culture confirmed TB were identified. Seven presented after a median 25 (range 8-54) days on highly active antiretroviral therapy (HAART) with pulmonary TB and one also had extra-pulmonary disease. Three of the patients had a prior history of TB and presented with relapse or recurrent disease. Four patients with TB developed a tuberculous paradoxical reaction; one died of suspected tuberculous immune reconstitution pneumonitis. The duration of pre-HAART anti-tuberculosis treatment and antiretroviral treatment ranged from 21 to 59 and 6 to 105 days, respectively, when they presented with a paradoxical reaction. Drug-resistant (isoniazid and rifampicin) TB was cultured from one patient with relapse disease. Chest radiograph features present during immune reconstitution were increasing or new intrathoracic lymphadenopathy, parenchymal infiltrates and pleural effusions.

Conclusion: This report documents the clinical presentation of TB during the early phase of HAART which may be attributed to HAART-mediated immune reconstitution. More research is needed to improve the accuracy of TB diagnosis in HIV-infected children.