INTRODUCTION: India is one of the largest and most populated countries in the world, with over one billion inhabitants. Of this number, it's estimated that around 2.4 million people are currently living with HIV. In recent decades, the dramatic spread of the HIV epidemic in sub-Saharan Africa has resulted in notification rates of TB increasing up to 10 times in some countries. The incidence of TB is also increasing in other high HIV prevalence countries, where the population with HIV infection and TB overlap. Even those countries with well organized national tuberculosis programs have seen an increase in TB cases. This is the underlying factor that suggests that TB control will not make much head way in HIV prevalent settings unless HIV control is also achieved. TB is the most common treatable HIV-related disease and a leading killer of people living with HIV/AIDS (PLWHA). The World Health Organisation (WHO) cites TB treatment as one of the most cost-effective health interventions available – at a cost of only $10 for every year of life gained. BACKGROUND OF THE STUDY: As HIV progressively destroys the immune system, there is a greater chance of a child infected with HIV developing tuberculosis. The development of active TB accelerates the progression of HIV disease towards full-blown AIDS, because the replication rate of the HIV virus is increased during the active phase of TB.
TB is curable, even in a children who is HIV positive. Curing an HIV positive children of TB not only improves their quality of life, and gives them several more years of life, it also reduces transmission to others in the community. TB is the most common treatable HIV-related disease and a leading killer of children living with HIV/AIDS. AIM OF THE STUDY: To screen for TB coinfection in HIV positive children registered in ART Centre , Madurai. DISCUSSION: 1.SEX DISTRIBUTION IN NEWLY DIAGNOSED CASES: Of the new HIV positive children, 57.7 %(n=26) and 42.2%(n=19) were male and female respectively. This was similar to S.Rajasekaran et al.,(40) study at Tambaram in which male & female children constituted 56.9 and 43.1 percent respectively . Male children outnumber female children by a small number. 2.CONTACT HISTORY: Of the 13 children screened positive for tuberculosis, 10 children ( 76.92%) had contact with an open case of TB and it was Statistically significant( p value <0.0001)
This was similar to Ira shah et al(41) study in which 70.7% had contact with an adult suffering from TB
Young children living in close contact with a source case of smear-positive pulmonary TB are at particular risk for TB infection and disease. The risk of infection is greatest if the contact is close and prolonged, such as that between an infant or toddler and the mother or other caregivers in the household. CONCLUSION: 1. HIV associated TB is a major public health problem. Tuberculosis co-infection in HIV infected children was found to be 12.6% in our study. This may be due to the impact of ART. ART has been shown to reduce the incidence of TB in treated cohorts even in high TB prevalence countries.
2. Source of childhood TB is usually an adult, who is in close contact with the children.
3. Mantoux is positive even in HIV- infected children. So mantoux is an important diagnostic tool even in HIV-infected children.
4. FNAC proved to be TB in only 2 cases . So Lymphnode – FNAC or biopsy is mandatory for children presenting with lymphadenopathy before starting empirical ATT.
5. With the conventional sputum positivity and Tuberculin test not providing an adequate diagnostic help, familiarity with clinco radiological spectrum of TB and HIV coinfection will help in early diagnosis
