Page 57 - Children Bookt.pdf

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TUBERCULOSIS AND HIV

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HIV infected children have the highest risk of developing progression to disease once
infected with Mycobacterium tuberculosis, the younger children being at the highest
risk.
Systematic review on impact of tuberculosis preventive therapy on tuberculosis and
mortality in HIV infected children showed that the outcome of HIV infected children
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was a higher rate of recurrence (Gray et al, 2009). Therefore prevention has become
an important strategy to reduce mortality and morbidity of TB in HIV/AIDS. Isoniazid

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TB infection the bacterial burden is small allowing the possibility of monotherapy.
Therefore to prevent the co infection of TB infection in HIV infected children one

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active TB disease in TB/HIV co infected patients which might not be so easy. Patient
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to administrate IPT.
To provide IPT to children, without active TB, who have contact with TB patients
(regardless of HIV co-infection) is a policy of NTP, approved by MOH. (Ref. National
guidelines on management of TB in children, NTP, 2007)

TB contact tracing should also be carried out in all the HIV infected children of all ages.

The recommended dose of Isonized (INH) for preventive therapy in HIV co infection
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presentation is compatible, regardless of whether IPT has been given.

Treatment of TB in HIV-infected infants and children 2
The underlying principles for the treatment of TB in HIV-infected children are the
same as for children who are not HIV-infected. However, the co-management of TB
and HIV, and the treatment of HIV infection, is complicated by drug interactions,
particularly between rifampicin and the NNRTI and PI classes of ARVs. These drugs
have similar routes of metabolism and co-administration may result in sub-therapeutic
drug levels. ART should not be interrupted but dose adjustments of ART may be needed
when taken with the rifamycins, especially rifampicin. The potential use of rifabutin,
considered in adults to overcome drug – drug interactions, is not recommended due

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choice of ART regimen in TB/HIV co infected children is complicated by the relatively
limited number of available pediatric ARV formulations and the lack of dosing
information for some ARVs (particularly for children less than 3 years of age).

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