Clinical correlate of tuberculosis in HIV co-infected children at the University of Abuja Teaching Hospital, Gwagwalada, Nigeria

Abstract

Background: Tuberculosis (TB) co-infection with HIV is becoming a global emergency especially in the sub-Saharan Africa. Its diagnosis is notoriously challenging in countries with poor resource settings with limited diagnostic facilities.

Objective: To determine the prevalence, pattern, outcome, and clinical risk factors of TB in HIV co-infected children in Abuja, Nigeria.

Materials and methods: An 18 months retrospective review of HIV-infected children diagnosed as having co-infection with TB was carried out at the special treatment clinic of the University of Abuja Teaching Hospital (UATH), Gwagwalada, from February 2007 to August 2008 for the above objectives.

Results: Of a total 210 HIV-infected children observed during the review period, 41 (19.5%) were diagnosed as having co-existing TB. Their mean age, weight, CD4 cell count and its percentage were 6.3 ± 2.4 years, 14.3 ± 3.4 kg, 262 ± 28.0 cells/ml, and 9.9%, respectively. Pulmonary TB accounted for 59% of all TB cases seen, while disseminated form was seen in 26.8%. Bone involvement was the least common form seen in only (2.4%) of cases. Confirmation of TB was only possible by positive smear and histology in 22.0% of cases, while 78.0% of cases remained unconfirmed. Co-infection was significantly higher in older children (>5 years) than in younger children <5 years (32 vs 9, P < 0.05). Severe weight loss was the only clinical feature found to have a fairly good sensitivity (88.9%) and specificity (88.6%) for TB in co-infected children, with a positive predictive value of 23.0%. While immune reconstitution syndrome (IRS) occurred in 2 (4.9%) of the patients, only one death (2.4%) was recorded among the co-infected children.

Conclusions: TB co-infection with HIV in children is common in this environment. Severe weight loss can be used as a clinical guide to identify HIV-infected children at risk of co-infection with TB who will require further evaluation.