Tuberculosis in children with human immunodeficiency virus infection

For a number of reasons--but especially the human immunodeficiency virus (HIV) epidemic--tuberculosis (TB) is currently increasing in many parts of the world where it threatens the lives of millions of infants and children. The diagnosis of childhood TB, which has always been difficult, is now even more challenging in infants and children co-infected with HIV and Mycobacterium tuberculosis. Both TB and HIV infection require multiple drugs for effective treatment and to prevent the development of resistance by the infecting agents. Drug-drug interactions are therefore common, and knowledge of these is essential in the management of dually infected infants and children. Due to problems with drug toxicity and the need for prolonged treatment, compliance is also a major issue in these children. Chemoprophylaxis against TB in HIV-infected children needs further research, as do the pharmacokinetics of antiretroviral drugs in children. Integrated management of children co-infected with TB and HIV should be encouraged, especially in resource-poor settings.