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HIV-associated pediatric tuberculosis

prevention, diagnosis and treatment

Kay, Alexandera,b; Garcia-Prats, Anthony J.c; Mandalakas, Anna Mariaa

Current Opinion in HIV and AIDS: November 2018 - Volume 13 - Issue 6 - p 501–506
doi: 10.1097/COH.0000000000000500
TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun
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Purpose of review The detrimental synergy of colliding HIV and tuberculosis (TB) epidemics is most devastating among children and adolescents living with HIV (CALWH) who shoulder a disproportionate burden of all child TB mortality.

Recent findings CALWH benefit less from Bacille–Calmette Guerin vaccination than HIV-uninfected children and are not receiving TB preventive therapy despite global recommendations. Further, the predictive utility of most diagnostic tools is reduced in CALWH. Finally, antiretroviral and anti-TB drug interactions continue to complicate cotreatment for children. Despite these challenges, recent data fuel a new awareness of TB as a hidden cause of child mortality and a renewed commitment to TB prevention. New diagnostic approaches using existing tools with novel specimens, such as stool, may improve the diagnosis of TB in CALWH. Further, pharmacokinetic studies and the development of new drug formulations promise better treatment options for CALWH in the near future.

Summary With the awareness that TB is the leading cause of mortality among CALWH, comes a responsibility to accelerate research to prevent, diagnose and treat TB in this vulnerable population. In the present, we must adopt evidence-based preventive and treatment strategies to enhance outcomes of CALWH and combating TB.

aThe Global TB Program, Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA

bBaylor College of Medicine Childen's Foundation Eswatini, Mbabane, Eswatini

cDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa

Correspondence to Anna Maria Mandalakas, MD, PhD, The Global TB Program, Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, 1102 Bates Street, FC 630, Houston, TX 77459, USA. Tel: +1 832 822 1331; e-mail: anna.mandalakas@bcm.edu

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