Diagnostic and management challenges for childhood tuberculosis in the era of HIV
Date
2007
Authors
Marais B.J.
Graham S.M.
Cotton M.F.
Beyers N.
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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. © 2007 by the Infectious Diseases Society of America. All rights reserved.
Description
Keywords
abacavir, antiretrovirus agent, BCG vaccine, corticosteroid, cotrimoxazole, efavirenz, ethambutol, isoniazid, placebo, proteinase inhibitor, pyrazinamide, rifampicin, rifamycin derivative, ritonavir, RNA directed DNA polymerase inhibitor, tuberculostatic agent, zidovudine, adult respiratory distress syndrome, Africa, BCG vaccination, childhood disease, clinical trial, conference paper, epidemic, fever, human, Human immunodeficiency virus infection, Human immunodeficiency virus prevalence, immune reconstitution inflammatory syndrome, infection risk, lymphadenopathy, Mycobacterium tuberculosis, pleura effusion, priority journal, recommended drug dose, sensitivity and specificity, tuberculin test, tuberculoma, tuberculosis, Anti-HIV Agents, Antitubercular Agents, Child, Child, Preschool, Drug Interactions, HIV, HIV Infections, Humans, Immune System Diseases, Immunologic Tests, Infant, Inflammation, Interferon Type II, Tuberculin Test, Tuberculosis, World Health
Citation
Journal of Infectious Diseases
196
SUPPL. 1
196
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