A better diagnosis of tuberculosis in HIV infected children

A new path is opened to detect efficiently and rapidly tuberculosis in HIV-infected children. The Xpert® MTB/RIF[1] molecular test, already shown to be efficient for tuberculosis detection in HIV seropositive adults, was evaluated in a prospective cohort study of HIV-positive children aged below 14 years (ANRS 12229 PAANTHER Study). This study, undertaken by a researcher of the “Infectious Diseases in lower-income countries – IDLIC” team, from Bordeaux Population Health U1219 research Center shows encouraging results. The study was made in collaboration with an international team, and published in the April issue of the international journal Clinical infectious diseases.

Physician and researcher at the Bordeaux Population Health INSERM research center, Olivier Marcy has made a thesis about the topic, “Detection of tuberculosis in HIV infected children”. This disease is the leading infectious cause mortality in the world, especially in Asia and Africa. Approximately 10% of tuberculosis deaths affect children, which represents 400 children who die from tuberculosis every day.

Diagnosis of pediatric tuberculosis is a challenge for many reasons: the small amount of bacilli in the lungs, the difficulties to perform samples (by gastric apsirates), and the need to use very sensitive tests. The results of the two-year prospective cohort study ANRS 12229 PAANTHER 01, which was conducted in eight hospitals in Burkina Faso, Cambodia, Cameroun and Viet-Nam, and enrolled 272 HIV-infected children are now published in the CID journal.
The IDLIC team, in collaboration with the Institut Pasteur in Cambodia and many researchers in France and 4 others countries, showed the efficiency of the Xpert® MTB/RIF test, an automated and quick nucleic acid amplification test. Performed on nasopharyngeal aspirates and stools samples, the test is very efficient to diagnose tuberculosis. During this study, tuberculosis was confirmed by culture in 29/272 (10.7%) children. Xpert MTB/RIF detected 23 (79%) of culture-confirmed cases and as many cases overall as culture (29).

“Our goal is to increase the number of HIV-infected children on treatment for tuberculosis and reduce this dreadful figure of 400 children dying every day of tuberculosis.”
Olivier Marcy, coordinating investigator of the study.

This study is funded by the Inserm-ANRS (France REcherche Nord&sud Sida-hiv Hépatites) and allows new perspectives on tuberculosis diagnosis on children. Associating new and less invasive collection methods, a more efficient molecular test, and more effective blood tests, the PAANTHER study takes part in a worldwide public health resolution phenomenon. This action is in fact related to the strategy to fight tuberculosis led by the World Health Organization which plans to eradicate the epidemic in 2030.

Marcy, O., V. Ung, et al. (2016). “Performance of Xpert MTB/RIF and Alternative Specimen Collection Methods for the Diagnosis of Tuberculosis in HIV-Infected Children.” Clinical Infectious Diseases 62(9): 1161-1168. first published online February 7, 2016 doi:10.1093/cid/ciw036

Link  : http://m.cid.oxfordjournals.org/content/early/2016/02/21/cid.ciw036.short?rss=1&related-urls=yes&legid=cid%3bciw036v2

[1] More informations about test Xpert® : http://www.who.int/bulletin/volumes/91/3/13-020313/fr/

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