The diagnosis and management of tuberculosis in HIV-infected children

Abstract

Human immunodeficiency virus (HIV) infection has made the diagnosis of tuberculosis (TB) in children more complex, despite it presenting in similar ways as in HIV-uninfected chilren. A history of contact with an infectious source case is often the first hint of the diagnosis. Both TB and HIV cause failure to thrive. HIV is often associated with other chronic lung disease and pulmonary TB may present as acute pneumonia. Current South African National Tuberculosis Control Programme guidelines recommend a six-month rifampicin (RMP)-based treatment regimen for HIV-infected and HIV-uninfected TB cases. Alternative regimens without RMP are not recommended. Drug-drug interactions occur with antituberculosis treatment and highly active antiretroviral therapy (HAART), mainly between RMP,which induces the P450iso-enzyme system, and the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors. Current recommendations for first line HAART in children on RMP-based TB treatment are: stavudine/lamivudine/ritonavir for children less than 3 years of age, and stavudine/lamivudine/efavirenz for children older than 3 years of age. Antituberculosis drugs and antiretroviral drugs have many toxicity profiles in common. For this reason, initiation of HAART should be delayed in children with dual infection unless HIV infection is at an advanced stage.