Profile of HIV and multidrug-resistant tuberculosis in orphans living in orphanages in Mumbai, Maharashtra, India

AIMS: The aim was to study the clinical profile of HIV-infected orphans living in orphanages in Mumbai, Maharashtra, India and determine the prevalence of multidrug-resistant (MDR) tuberculosis (TB) in them. MATERIALS AND METHODS: Seventy-four HIV-infected orphans from two orphanages (orphanage A taking antiretroviral therapy [ART] as per our prescription, whereas orphanage B taking ART from an ART center) were included in the study. Detailed history and examination was carried out in each patient. CDC class prior to ART, age at presentation, CD4 count/percent, opportunistic infections (OIs) prior to and after ART, co-infections with hepatitis B virus (HBV) and hepatitis C virus, growth, ART regimes, and treatment failure were noted in each patient. RESULTS: Of 18 HIV-infected children in orphanage A, boys constituted 11 (61.1%) and girls were 7 (38.9%), whereas orphanage B had all girls (n = 56). TB was the most common OI in orphanage A prior to the start of ART seen in 15 (83.3%), whereas it was seen in 18 (32.1%) in orphanage B. In contrast, TB was seen in eight (14.2%) orphans in orphanage B after the start of ART, of which two (3.5%) were MDR-TB and another two (3.5%) were suspected to have MDR-TB, whereas one (5.5%) in orphanage A had MDR-TB. Age of presentation was 4.7 ± 3.2 years for orphanage A and 12.9 ± 2.5 years for orphanage B. On ART, malnutrition was seen in one child in orphanage A as compared to nine in orphanage B. ART was started at 6.1 ± 3.1 years in orphanage A and 10.1 ± 2.8 years in orphanage B. Zidovudine, lamivudine (3TC), and nevirapine (NVP)/efavirenz (EFV) constituted the baseline ART regimen in 13 (72.1%) orphans in orphanage A, whereas stavudine (d4T) + 3TC + NVP constituted the baseline ART in 17 (30.3%) orphans in orphanage B. Three (5.3%) orphans had HBV co-infection in orphanage B. CONCLUSION: Children in orphanage A came to us at a younger age, in more advanced stage of disease, and were more malnourished. Orphanage A was started on ART earlier in life. The prevalence of TB was higher in orphanage A prior to ART. MDR-TB was seen in both orphanages, with prevalence ranging from 3.5% to 5.5%.