Management of co- HIV and TB infected children on HAART: GHESKIO’s experience

Background: TB and HIV are the more frequent cause of morbidity and mortality in developing countries. This abstract presents the outcome of patients requiring therapy for both Methods : theTB diagnosis in children is made by clinical correlation, PPD, chest radiograph, sputum analysis (>10years old) and history of exposure. The regimens used are AZT, 3TC and abacavir for HIV and INH, RIF, ETH, PZA for TB. In 2005, 44 of 92 new cases of TB were HIV +:
- 24 were placed only on TB therapy (TBX)
- 20 were placed on both HAART and TBX:
Group 1: 16 started HAART 2 months after TBX
Group 2: 3 started TBX 3 months after HAART
1 started TBX and HAART at the same time because of advanced HIV disease (CD4=2; 0,06%)
Patients were offered nutritional support and monitored closely for clinical deterioration and the need to start HAART
Results: Management of 20 patients on dual HAART and TBX was challenging:
- All were in clinical stage C
- From poor families
- 90% malnourished
- 70% orphans
- 3 not fully adherent
Six months post HAART initiation:
- 1 patient who started concomitant HAART and TBX died and
- 19/20 are alive and well
The mean CD4 count for the 19 patients increased from a baseline of 317 to 526 (absolute count) , and from 8,32% to 13,7% (% count ). In group 1 CD4 increased from 334 (9%) to 567 (17%) and in group 2 CD4 increased from 252 (4.76%) to 463 (9.29%) .The mean weight gain was 17,86 pounds for the 19 patients .
Conclusions: Despite the many challenges encountered in the management of HIV and TB co- infection, the great majority of patients responded well to HAART and TB therapy.

R.M.G. Bois1, F. Noel2, L. Estavien2, A. Jules2, J. Charlemagne2, P.F. Wright3, J.W. Pape4
1Centres GHESKIO, Pediatrics, Port-au-Prince, Haiti, 2Les Centres GHESKIO, Pediatrics, Port-au-Prince, Haiti, 3Vanderbilt, Pediatrics, Vanderbilt, United States, 4Les Centres GHESKIO, Research, Port-au-Prince, Haiti