HIV and TB: an overview

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HIV and TB an overview

• Mark Cotton
• Childrens Infectious Disease Clinical Research
  Unit (KID-CRU)
• Faculty of Health Sciences
• Stellenbosch University
• Tygerberg Childrens
• Hospital

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World population with infection by M tuberculosis
versus HIV
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Tuberculosis disease versus HIV
Sources WHO report 2005 UNAIDS
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Incidence TB 1997
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In endemic areas, TB occurs commonly

• In any healthcare setting

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Active TB Case Finding pMTCT Program, Soweto, RSA

• 366 pregnant women assessed by symptoms
• 8 active TB (2.2)
• Interview questions added 3 minutes to routine
  visit

Kali et al World AIDS Congress Bangkok, 2005
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HIV-exposed infants 4w-4m screened for
prospective studies, June - Oct 2005 KID-CRU,
Tygerberg, Western Cape
P1041 and CIPRA-SA
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HIV-exposed infants aged 4w-4m screened for
prospective studies

• 6.5 exposed to TB
• 27.5 correctly managed identified by Health
  Care System
• 0.4 TB disease

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TB exposure, intervention disease per 100 000
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HIV found commonly adults children with TB

• Adults and children with HIV commonly have /
  treated for TB

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TB in HIV-infected children

• Increased risk TB in HIV-infected children,
  57/138 (41) Jeena 2002
• M. tb in 18 Zambian children dying of
  respiratory disease (post mortem)
• 8 children hospitalized with acute pneumonia Zar
  2000, Graham 2000, Madhi 2000

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NTP - National TB programsLinked to WHO

• Collect indicator data such as
• Smear positive Infectious (HIV-ve adults)
• Will include children smear-negative cases
• Sputum conversion
• Treatment completed
• Retreatment More resistance

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Tuberculosis in Thailand 2002
Estimated incidence 140/100,000 population
2.5 are children gtgt underestimation?
www.moph.go.th
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Seroprevalence of HIV in New TB Thailand,1990-2002
HIV-infected patients with TB 20 - 25 TB
patients with HIV infection 14 - 15
From Bureau of AIDS TB STI, MOPH
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23.4 per 100 HIV-infected children get
tuberculosis disease per year in Western Cape,
South Africa

• 132 children - median follow-up 5.7 (IQR 2 - 9.7)
  m
• Heather Zar and Mark Cotton - 2005

10 on HAART
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BCBosis - emerging disease

• All neonates immunized in 1st 2 days of life
  regardless of HIV status

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Hesseling AC, et al. Danish BCG Disease in
HIV-Infected Children Clin Infect Dis
2003371226-33.

• 5 infants with advanced immune suppression
• BCG ipsilateral regional axillary adenitis and/or
  systemic BCG disease
• All lt 1 year of age at presentation
• mortality 80

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Retrospective study of BCG complications - Anneke
Hesseling Helena Rabie - 2005
Disseminated disease - 75 mortality
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DRUG RESISTANCE IN CHILDHOOD TUBERCULOSIS -
comparison of 2 surveys

• Schaaf HS, Marais BJ, Hesseling AC, Gie RP,
  Beyers N, Donald PR
• Department of Paediatrics and Child Health,
  Stellenbosch University and Tygerberg Childrens
  Hospital

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Drug susceptibility testing (DST)

• 1st for INH and RMP, and if resistant to either
  or both, also for ethambutol (NTP guidelines)
• Indirect proportional method

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HIV prevalence
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Increasing Drug Resistance
323
338
OR Drug resistant 0.49 (0.27-0.88) MDR
0.40 (0.15-1.04)
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STOP TB strategy
Vision - a TB-free world
GOALS Detect 70 infectious cases cure 85 by
2005 Reduce death due to TB by 50 by
2015 Eliminate TB as public health problem by
2050
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6 components for strategy implementation plan

• Address TB/HIV, MDR TB other special challenges
• TB/HIV collaborative strategy
• Prevention control drug resistance
• Enable promote research
• Operational
• Partnerships for new diagnostics, drugs vaccines

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Acknowledgements

• Nirun Vanprapar
• H Simon Schaaf
• Helena Rabie
• Anneke Hesseling
• Heather Zar