Abstract
HIV-infected children have a high risk of acquiring tuberculosis. The World Health Organization (WHO) has released isoniazid preventive therapy (IPT) recommendations for adults and children living with HIV, based on efficacy studies, mainly in adults. Data from children appear conflicting. IPT guidelines for children were developed in response to WHO guidelines at a local meeting, followed by discussions. 
 
 IPT should be given to all HIV-infected children after exposure to a source case if treatment for active disease is not required. For children whose mothers’ HIV status was known antentally, when tuberculosis has been actively excluded in mothers and at infant follow-up, and when infants have commenced antiretroviral therapy in the first 3 months of life, IPT is not required. Otherwise, all infants and children should be given IPT for 6 months once active tuberculosis has been excluded.
Highlights
HIV-infected children have a high risk of acquiring tuberculosis
For children whose mothers’ HIV status was known antentally, when tuberculosis has been actively excluded in mothers and at infant follow-up, and when infants have commenced antiretroviral therapy in the first 3 months of life, isoniazid preventive therapy (IPT) is not required
This study suggests that IPT and antiretroviral therapy (ART) have additive benefit in HIV-infected children
Summary
The WHO has recently published guidance on IPT for both children and adults, mainly based on adult data.[13]. Low quality of evidence C omment: All suspected cases MUST be referred for exclusion of TB according to local guidelines The timing of this screening is important to avoid excessive referrals. Moderate quality of evidence C omment: The implication is that all HIV-infected children should receive IPT once active TB has been excluded, regardless of their underlying condition. This recommendation brings IPT guidelines for children in line with those for adults. 1.5 All children living with HIV who have successfully completed treatment for TB disease should receive INH for an additional 6 months.[15] Conditional recommendation, low quality of evidence
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