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Tuberculosis in children who are HIV-exposed uninfected

Jeffrey I Campbell1, Ojasvi Vachharajani2, Melanie M Dubois3

  • 1Section of Pediatric Infectious Diseases, Boston Medical Center.

AIDS (London, England)
|May 15, 2026
PubMed

Insights

Children exposed to HIV but uninfected (cHEU) have similar tuberculosis risks as HIV-unexposed children. However, cHEU show a lower risk of TB disease compared to children living with HIV.

Area of Science:

  • Pediatric infectious diseases
  • HIV/AIDS research
  • Tuberculosis epidemiology

Background:

  • 1.3 million HIV-uninfected children are born annually to mothers with HIV.
  • Over 70% of these children reside in high tuberculosis (TB) burden areas.
  • The TB risk in HIV-exposed but uninfected children (cHEU) is debated.

Purpose of the Study:

  • To systematically review and meta-analyze TB infection and disease risks in cHEU.
  • Compare TB risks between cHEU and HIV-unexposed uninfected children (cHUU).
  • Compare TB risks between cHEU and children with HIV (CWH).

Main Methods:

  • Systematic review and meta-analysis of studies on TB infection and disease.
  • Searched multiple databases (PubMed, Embase, Web of Science, CINAHL) through October 2025.
  • Analyzed TST/IGRA positivity and cumulative TB disease incidence.

Main Results:

  • Included 26 studies for review, 18 for meta-analysis; most focused on children under 2 years.
  • TB infection (TST/IGRA positivity) and disease incidence were similar between cHEU and cHUU.
  • cHEU showed a lower cumulative incidence of TB disease compared to CWH.

Conclusions:

  • cHEU and cHUU share comparable risks for TB infection and disease.
  • cHEU exhibit a reduced risk of TB disease when compared to children living with HIV.
  • Study limitations include a lack of data beyond infancy and a small number of included studies.
Abstract

Keywords:
HIV-exposedchildmaternal HIVtuberculosis

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