Timing of HIV diagnosis in children with tuberculosis managed at a referral hospital in Cape Town, South Africa

S E T T I N G: Tygerberg Hospital, Western Cape Province, Cape Town, South Africa. O B J E C T I V E: To investigate the prevalence of and factors associated with simultaneous tuberculosis (TB) and human immunodeficiency virus (HIV) diagnoses in children. D E S I G N: Retrospective cohort study in TB-HIV co-infected children aged,13 years admitted to Tygerberg Hospital in 2012. Data were collected from medical records, laboratory results and electronic TB treatment registers. A simultaneous TB-HIV diagnosis was defined as an HIV diagnosis made within 7 days before or after a diagnosis of TB. R E S U LT S: Of 88 children with TB-HIV co-infection, 37 (42%) had a simultaneous TB-HIV diagnosis; 51 children had been known to have HIV before their TB diagnosis. Interruption of antiretroviral therapy (ART) was reported in 9/32 (28%) children with known HIV infection at TB diagnosis, while missed opportunities for ART initiation were identified in 8/19 (42%) ART-naïve children. Simultaneous TB-HIV diagnosis was more likely if maternal HIV infection was unknown at the time of the child's birth (OR 2.7, 95%CI 1.0-7.2), and was associated with unfavourable TB treatment outcomes (OR 5.9, 95%CI 1.4-25.2). C O N C L U S I O N: TB diagnosis provides an important opportunity to test children for HIV. Missed opportunities for HIV prevention, earlier diagnosis and ART initiation were identified.