Background: Children < 5 years, particularly CLHIV, are at risk for rapid progression of tuberculosis (TB). Limited data are available on the clinical presentations and pathways to TB diagnosis in CLHIV. We describe TB clinical presentations and diagnostic pathways in CLHIV in comparison with children living without HIV in Cameroon and Kenya.
Methods: This study was a sub-analysis of a trial evaluating the integration of pediatric TB services from May 2019 to March 2021. Children age <5 years diagnosed with TB were enrolled. Clinical and diagnostic characteristics were compared between CLHIV and children without HIV. Univariate and multivariate logistic regression analysis were performed with adjusted odds ratios (AORs) displayed.
Results: Of the 157 participants enrolled, 57% (n=89) were male. The mean age was 1.5 years, with 14.0% (22/157; 95%CI [9.0%-20.4%]) of them co-infected with HIV. CLHIV were more likely to initially present with severe or moderate acute malnutrition (AOR 3.16 [1.14-8.71]). Most TB diagnoses (89%;140/157) were made clinically with pulmonary TB being the most common in both groups; however, bacteriologic confirmation tended to be more frequent in CLHIV, 18% vs 9% (p=0.06), due to the contribution of LF‐LAM. Fatigue (AOR: 6.58 [2.28-18.96]), HIV positivity (AOR: 6.10 [1.32-28.17]) and existence of a household contact diagnosed with TB (AOR: 5.60 [1.58-19.83]), were independently associated with a shorter time to TB diagnosis whereas older age (AOR: 0.35 [0.15-0.85] for age 2-5 years), night sweats (AOR: 0.24 [0.10-0.60]) and acute malnutrition (AOR: 0.36 [0.14-0.92]) were associated with a delayed diagnosis.
Conclusions: The TB case-finding strategies should better target CLHIV with moderate or severe acute malnutrition. The integration of TB services into pediatric entry points should have a focus on HIV and nutrition services, with the aid of advanced non-sputum-based diagnostics, will lead to earlier, more rapid TB diagnoses preventing the high mortality rate in this special population.