HIV-Associated Tuberculosis in Children and Adolescents: Evolving Epidemiology, Screening, Prevention and Management Strategies

Abstract

Children and adolescents living with HIV continue to be impacted disproportionately by tuberculosis as compared to peers without HIV. HIV can impact TB screening and diagnosis by altering screening and diagnostic test performance and can complicate prevention and treatment strategies due to drug-drug interactions. Post-tuberculosis lung disease is an underappreciated phenomenon in children and adolescents, but is more commonly observed in children and adolescents with HIV-associated tuberculosis. This review presents new data related to HIV-associated TB in children and adolescents. Data on the epidemiology of HIV-associated TB suggests that an elevated risk of TB in children and adolescents with HIV persists even with broad implementation of ART. Recent guidance also indicates the need for new screening strategies for HIV-associated TB. There have been major advances in the availability of new antiretroviral medications and also TB prevention options for children, but these advances have come with additional questions surrounding drug-drug interactions and dosing in younger age groups. Finally, we review new approaches to manage post-TB lung disease in children living with HIV. Collectively, we present data on the rapidly evolving field of HIV-associated child tuberculosis. This evolution offers new management opportunities for children and adolescents living with HIV while also generating new questions for additional research.

Keywords: HIV; adolescent; child; tuberculosis.

Figure 1

TB screening approaches in children <10 years. The performance of screening strategies was compared via evidence identified through a systematic review of the literature [19]. Approach 1: One or more of cough, fever, or poor weight gain in tuberculosis contacts (evidence derived from 4 studies with tuberculosis prevalence ranging from 2% to 13%). Approach 2: One or more of cough, fever, poor weight gain, or tuberculosis close contact (World Health Organization four-symptom screen) in children living with HIV, outpatient (evidence derived from 2 studies with tuberculosis prevalence ranging from 3% to 8%). Approach 3: CXR with any abnormality in tuberculosis contacts (evidence derived from 8 studies with tuberculosis prevalence ranging from 2% to 25%).