From: Tuberculosis and pneumonia in HIV-infected children: an overview
HIV-infected and exposed uninfected (HEU) children are at high risk of developing TB | High likelihood of household TB exposure early in life; disproportionate TB/HIV burden in young mothers |
Advanced disease, low CD4 count and malnutrition are additional risk factors | |
All children with HIV must be regularly screened for TB exposure and disease | |
BCG vaccination is contra-indicated in children known to be HIV-infected | |
Strategies to prevent TB | High community penetration of adult ART will reduce TB transmission in communities |
Universal early ART initiation in all HIV-infected | |
Appropriate use of INH preventative therapy | |
Active TB Case finding | |
Infection prevention and control strategies | |
History of contact | |
Early diagnosis of TB | Symptoms can overlap with other opportunistic infections |
Pulmonary and extrapulmonary disease possible | |
Pulmonary TB can present like acute pneumonia | |
A positive TST (≥5 mm) or IGRA confirms TB infection but not disease | |
CXR is important; HIV-infected children more likely to have alveolar opacification and lung cavities | |
Collect specimens for culture and Xpert MTB/RIF® as appropriate | |
Treating TB/HIV co-infection | Use appropriate/standard TB treatment regimen |
Adapt the ART regimen and dosing | |
Support adherence | |
Monitor for efficacy and side effects |