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High Prevalence of Tuberculosis Infection in HIV-1 Exposed Kenyan Infants

Cranmer, Lisa M. MD, MPH*†; Kanyugo, Mercy BSc; Jonnalagadda, Sasi R. PhD§; Lohman-Payne, Barbara PhD¶‖; Sorensen, Bess MSc; Maleche Obimbo, Elizabeth MB ChB, MMed, MPH; Wamalwa, Dalton MB ChB, MMed, MPH; John-Stewart, Grace C. MD, PhD*§¶‖

The Pediatric Infectious Disease Journal: April 2014 - Volume 33 - Issue 4 - p 401–406
doi: 10.1097/INF.0000000000000124
HIV Reports

Background: Infants born to HIV-1 infected mothers may have increased risk for tuberculosis (TB), but the prevalence of TB infection in this population is undefined. In contrast to tuberculin skin tests that are confounded by recent bacille Calmette-Guérin (BCG) vaccination, TB interferon gamma release assays (IGRAs) do not cross-react with BCG and enable detection of TB infection in infancy.

Methods: In a nested observational cohort of HIV-1 infected Kenyan mothers and their infants, we conducted T-SPOT.TB assays on cryopreserved peripheral blood mononuclear cells from 6-month-old infants without prior active TB. Maternal and infant correlates of infant TB infection were assessed.

Results: One hundred and eight-two infants were tested with T-SPOT.TB. Of 128 infants with determinate T-SPOT.TB results, the prevalence of a positive T-SPOT.TB was 10.9% [95% confidence interval (CI): 6.1–17.7%]. All infants were BCG–vaccinated and 7.0% were HIV-1 infected. Positive infant T-SPOT.TB was associated with maternal active TB (odds ratio: 15.5, 95% CI: 1.3–184; P = 0.04) and prolonged infant fever (>1 month) (odds ratio: 18.8, 95% CI: 1.6–223; P = 0.03).

Conclusions: We observed a high prevalence of TB infection in 6-month-old HIV-1 exposed infants. Improved TB detection and prevention are warranted in HIV-1 exposed infants at high risk for active TB disease.

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From the *Department of Pediatrics, University of Washington; Seattle Children’s Hospital, Seattle, WA; Department of Paediatrics, University of Nairobi, Nairobi, Kenya; §Department of Epidemiology; Department of Medicine; and Department of Global Health, University of Washington, Seattle, WA.

Accepted for publication September 25, 2013.

Supported by the US National Institutes Health NIH HD058477-01. L.C. is a Fellow of the Pediatric Scientist Development Program supported by an American Pediatric Society/American Academy of Pediatrics grant and NICHD K12-HD000850. B.L.-P. and D.W. were scholars in the International AIDS Training and Research Program, NIH Research Grant D43 TW000007, funded by the Fogarty International Center and the Office of Research on Women’s Health. G.J.-S. is supported by NIH Research Grant K24 HD054314-04. This publication was made possible with help from the University of Washington Center for AIDS Research, an NIH funded program (P30 AI027757), which is supported by the following NIH Institutes and Centers (NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA). The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Lisa M. Cranmer, MD, MPH, Division of Pediatric Infectious Diseases, Seattle Children’s Hospital, M/S MA.7.226, 4800 Sand Point Way NE, Seattle, WA 98105. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.