Diagnostic and management challenges for childhood tuberculosis in the era of HIV

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dc.contributor.authorMarais B.J.
dc.contributor.authorGraham S.M.
dc.contributor.authorCotton M.F.
dc.contributor.authorBeyers N.
dc.date.accessioned2011-05-15T16:03:33Z
dc.date.available2011-05-15T16:03:33Z
dc.date.issued2007
dc.description.abstractThe 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.
dc.description.versionConference Paper
dc.identifier.citationJournal of Infectious Diseases
dc.identifier.citation196
dc.identifier.citationSUPPL. 1
dc.identifier.issn221899
dc.identifier.other10.1086/518659
dc.identifier.urihttp://hdl.handle.net/10019.1/12674
dc.subjectabacavir
dc.subjectantiretrovirus agent
dc.subjectBCG vaccine
dc.subjectcorticosteroid
dc.subjectcotrimoxazole
dc.subjectefavirenz
dc.subjectethambutol
dc.subjectisoniazid
dc.subjectplacebo
dc.subjectproteinase inhibitor
dc.subjectpyrazinamide
dc.subjectrifampicin
dc.subjectrifamycin derivative
dc.subjectritonavir
dc.subjectRNA directed DNA polymerase inhibitor
dc.subjecttuberculostatic agent
dc.subjectzidovudine
dc.subjectadult respiratory distress syndrome
dc.subjectAfrica
dc.subjectBCG vaccination
dc.subjectchildhood disease
dc.subjectclinical trial
dc.subjectconference paper
dc.subjectepidemic
dc.subjectfever
dc.subjecthuman
dc.subjectHuman immunodeficiency virus infection
dc.subjectHuman immunodeficiency virus prevalence
dc.subjectimmune reconstitution inflammatory syndrome
dc.subjectinfection risk
dc.subjectlymphadenopathy
dc.subjectMycobacterium tuberculosis
dc.subjectpleura effusion
dc.subjectpriority journal
dc.subjectrecommended drug dose
dc.subjectsensitivity and specificity
dc.subjecttuberculin test
dc.subjecttuberculoma
dc.subjecttuberculosis
dc.subjectAnti-HIV Agents
dc.subjectAntitubercular Agents
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectDrug Interactions
dc.subjectHIV
dc.subjectHIV Infections
dc.subjectHumans
dc.subjectImmune System Diseases
dc.subjectImmunologic Tests
dc.subjectInfant
dc.subjectInflammation
dc.subjectInterferon Type II
dc.subjectTuberculin Test
dc.subjectTuberculosis
dc.subjectWorld Health
dc.titleDiagnostic and management challenges for childhood tuberculosis in the era of HIV
dc.typeConference Paper
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