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Tuberculosis in Children Living With HIV: Ongoing Progress and Challenges
Bryan J Vonasek1, Helena Rabie2,3, Anneke C Hesseling4
1Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Insights
Advances in pediatric tuberculosis (TB) and human immunodeficiency virus (HIV) coinfection lag globally. Optimizing prevention, diagnosis, and treatment for children living with HIV (CLHIV) is crucial to reduce mortality.
Area of Science:
- Pediatric Infectious Diseases
- Global Public Health
- HIV/TB Co-epidemiology
Background:
- Tuberculosis (TB) and human immunodeficiency virus (HIV) coinfection significantly impacts pediatric mortality worldwide.
- Progress in managing TB-HIV coinfection in children has lagged behind adult populations.
- Addressing the unique challenges of TB-HIV in children is critical for global health initiatives.
Approach:
- This review synthesizes recent research on the prevention, diagnosis, and treatment of HIV-associated TB in children.
- It evaluates current strategies and highlights emerging tools and therapeutic approaches.
- Key areas requiring further investigation are identified to guide future research efforts.
Key Points:
- Preventive measures like vaccination and TB preventive treatment require optimization for children living with HIV (CLHIV).
- Diagnosing TB in CLHIV remains challenging, though novel diagnostic tools show promise for improved accuracy and feasibility.
- Shorter TB treatment regimens and better understanding of antiretroviral-TB drug interactions are advancing care, but evidence gaps persist, especially for young children and drug-resistant TB.
Conclusions:
- Significant advancements have been made in TB-HIV coinfection management for children, yet substantial challenges remain.
- Further research is essential to optimize diagnostics, refine treatment strategies, and address drug-drug interactions, particularly in vulnerable pediatric populations.
- Accelerated efforts are needed to reduce the global burden of TB on CLHIV and improve child survival rates.
Abstract:
There has been much recent progress on control of the tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics globally. However, advances in children have lagged behind, and TB-HIV coinfection continues to be a major driver of pediatric mortality in many settings. This review highlights recent research findings in the areas of prevention, diagnosis, and treatment of HIV-associated childhood TB. Key areas for future research are defined. Current prevention efforts such as vaccination, TB symptom screening, and TB preventive treatment are demonstrated as beneficial but need to be optimized for children living with HIV (CLHIV). Diagnosis of HIV-associated TB in children remains a major challenge, depending heavily on clinicians' ability to judge an array of signs, symptoms, and imaging findings, but there are a growing number of promising diagnostic tools with improved accuracy and feasibility. Treatment of TB-HIV coinfection has also seen recent progress with more evidence demonstrating the safety and effectiveness of shorter regimens for treatment of TB infection and disease and improved understanding of interactions between antiretrovirals and TB medications. However, several evidence gaps on drug-drug interactions persist, especially for young children and those with drug-resistant TB. Accelerated efforts are needed in these areas to build upon current progress and reduce the burden of TB on CLHIV.
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