Mycobacterial disease incidence has dropped steadily through the combination antiretroviral therapy (cART) era in Spanish children with HIV. But HIV-positive children still have higher mycobacterial disease incidence than children without HIV.
This retrospective study analyzed mycobacterial disease incidence in children with and without HIV seen at hospitals across Spain from 1997 through 2008. Researchers divided study years into three periods: 1997-1999 (early cART), 2000-2002 (mid-cART), and 2003-2008 (late cART). The analysis included 1307 children with HIV and 5228 without HIV.
HIV-positive children had similar rates of tuberculosis and nontuberculous mycobacterial disease, and their overall incidence of mycobacterial disease was significantly higher than that of HIV-negative children (P < 0.001).
Among HIV-positive children with TB, 15 of 42 (35.7%) had pulmonary TB, and among those with nontuberculous disease, 9 of 42 (21.4%) had disseminated mycobacterial disease.
Overall rates of mycobacterial disease in HIV-positive children disease fell from 5.88 per 1000 child-years in 1997-1999 to 1.63 in 2003 to 2008 (P = 0.007) and from 4.20 in 2000-2002 to 1.63 in 2003-2008 (P = 0.021).
TB rates in children with HIV fell significantly from 3.53 per 1000 child-years in 1997-1999 to 0.84 in 2000-2002 (P = 0.016) and from 3.53 in 1997-1999 to 1.31 in 2003-2008 (P = 0.030). Rates of nontuberculous mycobacterial disease dropped from 3.36 per 1000 child-years in 2000-2002 to 0.32 in 2003-2008 (P = 0.002).
The researchers conclude that “the rate of mycobacterial disease decreased among HIV-infected children in the cART era, but the incidence of mycobacterial disease still remains higher than in the general population.”
Source: Julia Jensen, Alejandro Álvaro-Meca, Dariela Micheloud, Asunción Díaz, Salvador Resino. Reduction in mycobacterial disease among HIV-infected children in the highly active antiretroviral therapy era (1997–2008). Pediatric Infectious Disease Journal. 2012; 31: 278-283.
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