title: Diagnostic and management challenges for childhood tuberculosis in the era of HIV.
abstract: The diagnosis and management of childhood tuberculosis (TB) pose substantial challenges in the era of the human immunodeficiency virus (HIV) epidemic. The highest TB incidences and HIV infection prevalences are recorded in sub-Saharan Africa, and, as a consequence, children in this region bear the greatest burden of TB/HIV infection. The tuberculin skin test (TST), which is the standard marker of Mycobacterium tuberculosis infection in immunocompetent children, has poor sensitivity when used in HIV-infected children. Novel T cell assays may offer higher sensitivity and specificity than the TST, but these tests still fail to make the crucial distinction between latent M. tuberculosis infection and active disease and are limited by cost considerations. Symptom-based diagnostic approaches are less helpful in HIV-infected children, because of the difficulty of differentiating TB-related symptoms from those caused by other HIV-associated conditions. Knowing the HIV infection status of all children with suspected TB is helpful because it improves clinical management. HIV-infected children are at increased risk of developing active disease after TB exposure/infection, which justifies the use of isoniazid preventive therapy once active TB has been excluded. The higher mortality and relapse rates noted among HIV-infected children with active TB who are receiving standard TB treatment highlight the need for further research to define optimal treatment regimens. HIV-infected children should also receive appropriate supportive care, including cotrimoxazole prophylaxis, and antiretroviral therapy, if indicated. Despite the difficulties experienced in resource-limited countries, the management of children with TB/HIV infection could be vastly improved by better implementation of readily available interventions.
authors.affiliation: Desmond Tutu TB Centre, Tygerberg, South Africa. bjmarais@sun.ac.za
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
authors.forename: S M
authors.initials: SM
authors.lastname: Graham
authors.forename: M F
authors.initials: MF
authors.lastname: Cotton
authors.forename: N
authors.initials: N
authors.lastname: Beyers
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004347:Drug Interactions; D014943:Global Health; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007154:Immune System Diseases / Q000139:chemically induced; D007159:Immunologic Tests / Q000379:methods; D007223:Infant; D007249:Inflammation / Q000139:chemically induced; D007371:Interferon-gamma; D014374:Tuberculin Test; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D007371:Interferon-gamma