Reduction in mycobacterial disease among HIV-infected children in the highly active antiretroviral therapy era (1997-2008)

Abstract

Background: HIV-infected children are at increased risk of developing mycobacterial disease. The aim of this study was to estimate the change in mycobacterial disease rate in HIV-infected children and adolescents in the highly active antiretroviral therapy (HAART) era.

Methods: We carried out a retrospective study. Data were obtained from the records of the minimum basic data set of hospitals in Spain from 1997 to 2008. The epidemiologic trends of mycobacterial diseases were evaluated through the following 3 calendar periods: early-period HAART (1997-1999), midperiod HAART (2000-2002), and late-period HAART (2003-2008).

Results: We analyzed 1307 HIV-infected children and 5228 HIV-uninfected children. HIV-infected children had similar rate of tuberculosis (TB) and nontuberculous mycobacteria (NTM) disease, and they had an overall rate of mycobacterial disease higher than that of HIV-uninfected children (P < 0.001). In HIV-infected children, the highest rates were for pulmonary TB (15/42 [35.7%]) in the TB category and disseminated mycobacterium (9/42 [21.4%]) in the NTM category. The overall rate of mycobacterial disease (events per 1000 HIV-infected children-year) decreased from 1997-1999 to 2003-2008 (5.88-1.63, P = 0.007) and from 2000-2002 to 2003-2008 (4.20-1.63, P = 0.021). Furthermore, the rate of TB decreased from 1997-1999 to 2000-2002 (3.53-0.84, P = 0.016) and from 1997-1999 to 2003-2008 (3.53-1.31, P = 0.030), and the rate of NTM disease decreased from 2000-2002 to 2003-2008 (3.36-0.32, P = 0.002).

Conclusions: The rate of mycobacterial disease decreased among HIV-infected children in the HAART era, but the incidence of mycobacterial disease still remains higher than in the general population.