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.
Highlights
This review focuses on recent evidence regarding tuberculosis (TB) incidence, prevention, diagnosis and management in children and adolescents living with human immunodeficiency virus infection (CALHIV)
The first demonstrated that adolescents with perinatally acquired HIV had a TB incidence of 2.2/100 person years (PY) (95% confidence interval (CI) 1.6 to 3.1) compared to adolescents without HIV with a TB incidence of
These findings may reflect the persistently high force of TB infection in these settings, as data from low burden settings suggests a more significant decline in HIV-associated TB attributable to antiretroviral therapy (ART) uptake [9]. This persistent risk of incident TB coupled with an elevated risk of mortality from HIVassociated TB indicates the ongoing need for novel TB screening, diagnostic and preventive strategies for CALHIV
Summary
This review focuses on recent evidence regarding tuberculosis (TB) incidence, prevention, diagnosis and management in children and adolescents living with human immunodeficiency virus infection (CALHIV). This data demonstrates that while ART effectively reduces TB risk and improves outcomes among CALHIV in sub-Saharan Africa, the risk remains highly elevated compared to populations without HIV As a whole, these findings may reflect the persistently high force of TB infection in these settings, as data from low burden settings suggests a more significant decline in HIV-associated TB attributable to ART uptake [9]. These findings may reflect the persistently high force of TB infection in these settings, as data from low burden settings suggests a more significant decline in HIV-associated TB attributable to ART uptake [9] This persistent risk of incident TB coupled with an elevated risk of mortality from HIVassociated TB indicates the ongoing need for novel TB screening, diagnostic and preventive strategies for CALHIV. The long-term impact of COVID-19 on TB and HIV-associated TB in children must be watched closely
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