Tuberculosis and HIV co-infection in children

Abstract

HIV is the top and tuberculosis is the second leading cause of death from infectious disease worldwide, with an estimated 8.7 million incident cases of tuberculosis and 2.5 million new HIV infections annually. The World Health Organization estimates that HIV prevalence among children with tuberculosis, in countries with moderate to high prevalence, ranges from 10 to 60%. The mechanisms promoting susceptibility of people with HIV to tuberculosis disease are incompletely understood, being likely caused by multifactorial processes.Paediatric tuberculosis and HIV have overlapping clinical manifestations, which could lead to missed or late diagnosis. Although every effort should be made to obtain a microbiologically-confirmed diagnosis in children with tuberculosis, in reality this may only be achieved in a minority, reflecting their paucibacillary nature and the difficulties in obtain samples. Rapid polymerase chain reaction tests, such as Xpert MTB/RIF assay, are increasingly used in children. The use of less or non invasive methods of sample collection, such as naso-pharyngeal aspirates and stool samples for a polymerase chain reaction-based diagnostic test tests and mycobacterial cultures is promising technique in HIV negative and HIV positive children. Anti-tuberculosis treatment should be started immediately at diagnosis with a four drug regimen, irrespective of the disease severity. Moreover, tuberculosis disease in an HIV infected child is considered to be a clinical indication for initiation of antiretroviral treatment. The World Health Organization recommends starting antiretroviral treatment in children as soon as anti-tuberculosis treatment is tolerated and within 2- 8 weeks after initiating it. The treatment of choice depends on the child’s age and availability of age-appropriate formulations, and potential drug interactions and resistance. Treatment of multi-drug resistant tuberculosis in HIV-infected children follows same principles as for HIV uninfected children. There are conflicting results on effectiveness of isoniazid preventive therapy in reducing incidence of tuberculosis disease in children with HIV.ConclusionData on HIV/TB co-infection in children are still lacking. There are on-going large clinical trials on the prevention and treatment of TB/HIV infection in children that hopefully will help to guide an evidence-based clinical practice in both resource-rich and resource-limited settings.

Inherited and acquired immunodeficiencies underlying tuberculosis in childhood

“…One of the key unanswered questions in the field of childhood TB concerns the nature of predisposition to the development of severe clinical forms in only a minority of infected children. HIV infection predisposes subjects to severe forms of childhood TB, but such infection is observed in only a small fraction of TB affected children . The last decade has provided a new clue to help us solve this riddle, by showing that at least some cases of severe TB, in HIV‐seronegative children, can be explained by single‐gene inborn errors of immunity .…”

Commiphora leptophloeos Phytochemical and Antimicrobial Characterization

“…Moreover, TB is the leading cause of deaths by HIV-positive individuals as, in 2015, 1 in 3 HIV deceases was linked to TB infection. In the context of multidrug-resistance, approximately 480 000 people developed multidrug-resistant TB (MDR-TB) worldwide and the major causes are inappropriate treatment, misuse of drugs or use of poor quality medicines (Venturini et al, 2014; WHO, 2015). …”

Immunologic and Virologic Responses to Nevirapine Based Antiretroviral Therapy (ART) Among HIV-tuberculosis Co-infected Ugandan Children on Rifampicin Based Anti-tubercular Treatment

“…There are limited published studies directly evaluating the effect of rifampicin on immunologic and virologic outcomes in HIV-TB co-infected children on NVP based ART regimens and it is important to study this because unlike adults, children tend to have higher viral loads and are thus less likely to be adequately suppressed with lower plasma NVP drug levels. 18 Rifampicin is a known strong inducer of cytochrome P450 and as such results in reduced plasma concentrations of NNRTIs and PIs if used concurrently with these drugs. 19 Both adult and paediatric studies done in Africa, Thailand and India have shown varying levels of the effect on NVP plasma levels as a result of the drug-drug interaction during concomitant use of a rifampicin containing anti-TB regimen and a NVP based ART regimen.…”