HIV in Children


Dr. Ira Shah
Last Updated : 1st September 2012
There is an increased risk of Tuberculosis among HIV - infected children (13) and infact co-infection with HIV occurred in up to 48% of children with culture proven TB (14, 15). Extra pulmonary and miliary TB are more common among younger children.

Children usually get TB from an infected close adult and disease in children is usually a primary infection rather than reactivation disease (16).An asymptomatic child with a positive Mantoux test suggests a latent infection and all latent infections should be treated to prevent the disease. Drug resistance TB is on the rise and thus contacts to drug resistant TB should be treated with the assumption that any newly diagnosed infection is similarly drug resistant.

If there is any patient with Tuberculosis then all exposed family members should be screened for TB to find secondary TB cases and patients with latent TB infection.

Clinical features

Pulmonary TB :

May be non-specific symptoms such as fever, weight loss, failure to thrive and cough. Features of presentation in HIV infected children is similar to those among non HIV infection.

Young children present with localized pulmonary infiltrates with hilar adenopathy. 25% of children may have more than 1 lobe involved. Middle lobe collapse and consolidation may result due to endobronchial tuberculosis. Older children and adolescents may present with cavitatory tuberculosis. Cavitatory upper lobe tuberculosis is more common in those with CD4 counts >200/mm3, whereas hilar /mediastinal adenopathy and diffuse pulmonary infiltrates (without cavitation) are more common in those with CD4 counts <200/mm3.

Extrapulmonary TB :

Common sites involved are lymph nodes, Disseminated TB, CNS FB, Bone TB and TB of the serosal surfaces.

Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.