Virologic and immunologic status of children with HIV-TB co-infections

  • Djatnika Setiabudi Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia https://orcid.org/0000-0002-7488-4377
  • Citra Cesilia Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia https://orcid.org/0000-0001-8914-0285
  • Almira Aliyannissa Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital https://orcid.org/0000-0002-9479-7369
  • Heda Melinda Nataprawira Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia https://orcid.org/0000-0001-8079-6544
Keywords: HIV, children, Indonesia, poor outcome, TB co-infection

Abstract

Background Studies about virologic and immunologic status of HIV children are lacking. Tuberculosis (TB) is the most common opportunistic infection in HIV patients and co-infection is associated with much worse prognosis.

Objective To describe the virologic and immunologic status of patients  with HIV and TB co-infection, before and after HIV and TB treatment.

Methods A prospective study was conducted in HIV  co-infected with TB patients in an Indonesian tertiary hospital between November 2016—December 2018. Viral load and CD4 levels were performed at diagnosis and after 6 months of HIV and TB treatment.

Results Of 44 children hospitalized due to HIV, 15 newly diagnosed HIV cases had TB co-infection. Thirteen were included as subjects. Most patients (10/13) were under 5 years of age, with similar female and male proportions (7/13 vs. 6/13, respectively). All were diagnosed with stage 4 HIV. Six patients had respiratory problems at admission. First examinations revealed severe immunodeficiency (CD4+ <20%) in all patients, and high viral loads (>105 copies/mL) in most (9/13) patients. Despite good compliance to medications, 8/13 patients died before the sixth month follow-up. Deterioration of virologic and immunologic status was seen in 3/4 of the followed-up patients.

Conclusion  Children with HIV-TB coinfections have severe immunodeficiency and high viral loads. Most such patients die before 6 months, while survivors experience virologic and immunologic status deterioration. Future study must take into account for HIV drug resistance investigation.

References

1. UNICEF. Global and regional trends. 2018. [cited 2019 July 23]. Available from: https://data.unicef.org/topic/hivaids/global-regional-trends/.
2. Belay M, Bjune G, Abebe F. Prevalence of tuberculosis, HIV, and TB-HIV co-infection among pulmonary tuberculosis suspects in a predominantly pastoralist area, Northeast Ethiopia. Glob Health Action. 2015;8:27949. DOI: 10.3402/gha.v8.27949.
3. Ali SA, Mavundla TR, Fantu R, Awoke T. Outcomes of TB treatment in HIV co-infected TB patients in Ethiopia: a cross-sectional analytic study. BMC Infect Dis. 2016;16:640. DOI: 10.1186/s12879-016-1967-3.
4. Adejumo OA, Daniel OJ, Adebayo BI, Adejumo EN, Jaiyesimi EO, Akang G, et al. Treatment outcomes of childhood TB in Lagos, Nigeria. J Trop Pediatr. 2016;62:131–8. DOI: 10.1093/tropej/fmv089.
5. Infodatin. Situasi umum HIV/AIDS dan tes HIV. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan RI; 2018. Available from: https://pusdatin.kemkes.go.id/ article/view/19042200004/situasi-umum-hiv-aids-dan-tes-hiv.html.
6. Pusat Data dan Informasi. Tuberkulosis. Jakarta: Kemenkes RI; 2018. Available from:
https://pusdatin.kemkes.go.id/article/view/18101500001/infodatin-tuberkulosis-2018.html.
7. World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. 2016. [cited 2019 July 23]. Available from: http://www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf.
8. World Health Organization. Nutrition Landscape Information System (NLIS) country profile indicators: interpretation guide. Nutr Landsc Inf Syst. 2010;1–51. Available from: https://apps.who.int/iris/handle/10665/44397.
9. Widyaningsih R, Widhiani A, Citraresmi E. Ko-infeksi tuberkulosis dan HIV pada anak. Sari Pediatr. 2016;13:55. DOI: 10.14238/sp13.1.2011.55-61.
10. Turkova A, Chappell E, Chalermpantmetagul S, Negra M Della, Volokha A, Primak N, et al. Tuberculosis in HIV-infected children in Europe, Thailand and Brazil: paediatric TB-HIV EuroCoord study. Int J Tuberc Lung Dis. 2016;20:1448–56. DOI: 10.5588/ijtld.16.0067.
11. Gao J, Zheng P, Fu H. Prevalence of TB/HIV co-infection in countries except China: a systematic review and meta-analysis. PLoS One. 2013;8:e64915. DOI: 10.1371/journal. pone.0064915.
12. Gupta RK, Lucas SB, Fielding KL, Lawn SD. Prevalence of tuberculosis in post-mortem studies of HIV-infected adults and children in resource-limited settings: a systematic review and meta-analysis. AIDS. 2015;29:1987–2002. DOI: 10.1097/QAD.0000000000000802.
13. Gray JM, Cohn DL. Tuberculosis and HIV coinfection. Semin Respir Crit Care Med. 2013;34:32–43. DOI: 10.1055/s-0032-1333469.
14. World Health Organization. TB causes 1 in 3 HIV deaths. HIV/AIDS. 2018. [cited 2019 July 23]. Available from: https://www.who.int/hiv/mediacentre/ news/hiv-tb-patient-centred-care/en/.
15. Venturini E, Turkova A, Chiappini E, Galli L, de Martino M, Thorne C. Tuberculosis and HIV co-infection in children. BMC Infect Dis. 2014;14:S5. DOI: 10.1186/ 1471-2334-14-S1-S5.
16. Maher D. Chapter 3: Management of TB in the HIV-infected child. Int J Tuberc Lung Dis. 2006;10:1331–6.
17. Moolasart V, Chottanapund S, Ausavapipit J, Likanonsakul S, Uttayamakul S, Changsom D, et al. The effect of detectable HIV viral load among HIV-infected children during antiretroviral treatment: a cross-sectional study. Children. 2018;5:6. DOI: 10.3390/children5010006.
18. Korenromp EL, Williams BG, Schmid GP, Dye C. Clinical prognostic value of RNA viral load and CD4 cell counts during untreated HIV-1 infection - a quantitative review. PLoS One. 2009;4:e5950. DOI: 10.1371/journal.pone.0005950.
19. Chauhan CK, Lakshmi PVM, Sagar V, Sharma A, Arora SK, Kumar R. Primary HIV drug resistance among recently infected cases of HIV in North-West India. AIDS Res Treat. 2019;2019:1525646. DOI: 10.1155/2019/1525646.
20. Kityo C, Sigaloff KC, Sonia Boender T, Kaudha E, Kayiwa J, Musiime V, et al. HIV drug resistance among children initiating first-line antiretroviral treatment in Uganda. AIDS Res Hum Retroviruses. 2016;32:628–35. DOI: 10.1089/aid.2015.0215.
Published
2021-03-16
How to Cite
1.
Setiabudi D, Cesilia C, Aliyannissa A, Nataprawira H. Virologic and immunologic status of children with HIV-TB co-infections. PI [Internet]. 16Mar.2021 [cited 21Feb.2024];61(2):94-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2518
Section
Infection & Tropical Pediatrics
Received 2020-11-04
Accepted 2021-03-16
Published 2021-03-16