Untangling the complex relationship between HIV-exposure and tuberculosis in children: a narrative review

Area of Science:

• Pediatrics
• Infectious Diseases
• Public Health

Background:

• Antiretroviral programs have reduced pediatric HIV, increasing the population of children HIV-exposed but uninfected (CHEU).
• CHEU demonstrate higher risks of morbidity and mortality compared to HIV-unexposed children, especially from infections.
• Tuberculosis (TB) is a significant concern in high HIV prevalence settings, making its impact on CHEU critical.

Purpose of the Study:

• To review and contextualize current literature on tuberculosis in children HIV-exposed but uninfected (CHEU).
• To explore the prevention, prevalence, and outcomes of tuberculosis infection and disease among CHEU.
• To identify knowledge gaps in the literature concerning CHEU and tuberculosis to inform future research directions.

Main Methods:

• Comprehensive literature review of studies focusing on children HIV-exposed but uninfected (CHEU) and tuberculosis.
• Analysis of existing data on tuberculosis prevention strategies, prevalence rates, and clinical outcomes in CHEU.
• Synthesis of findings to identify trends, consistencies, and discrepancies in the current body of knowledge.

Main Results:

• Growing evidence indicates increased susceptibility to infectious diseases, including tuberculosis, in CHEU.
• Data on tuberculosis prevention, specific prevalence rates, and long-term outcomes in CHEU remain limited.
• Significant gaps exist in understanding the full spectrum of tuberculosis risk and management in this vulnerable population.

Conclusions:

• CHEU represent a growing population with unique health vulnerabilities, particularly concerning tuberculosis.
• Further research is urgently needed to address the identified knowledge gaps in tuberculosis prevention, diagnosis, and management for CHEU.
• Understanding and mitigating tuberculosis risks in CHEU is crucial for improving child survival and health outcomes in high HIV-burden regions.