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

Setting Tygerberg Hospital, Western Cape Province, Cape Town, South Africa. Objective To investigate the prevalence of and factors associated with simultaneous tuberculosis (TB) and human immunodeficiency virus (HIV) diagnoses in children. Design Retrospective cohort study in TB-HIV co-infected children aged Results 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). Conclusion TB diagnosis provides an important opportunity to test children for HIV. Missed opportunities for HIV prevention, earlier diagnosis and ART initiation were identified.