Children living with HIV

Children living with HIV who do not have poor weight gain,* fever or
current cough are unlikely to have active TB.
Children living with HIV who have any one of the following symptoms –
poor weight gain*, fever, current cough or contact history with a TB case
– may have TB and should be evaluated for TB and other conditions.
If the evaluation shows no TB, they should be offered IPT regardless
of their age।
Encouraging efforts have been made to expand
access to early diagnosis of HIV in children as part
of HIV prevention, care and treatment. TB screening,
prevention and treatment should be an integral part
of these services. This section of the guidelines
is specifically targeted at children living with HIV.
However, in circumstances where HIV-exposed
infants and children are receiving HIV care pending
a result of a virological or serological test, they should
be considered as children living with HIV and get the
appropriate services until their results are known.
For infants less than 6 weeks of age and unknown
HIV exposure, and in settings where the HIV epidemic
is generalized (i.e. >1% prevalence in the population
attending antenatal care services), programmes are
strongly recommended to provide HIV serological
testing to mothers or their infants in order to establish
exposure status. Virological testing should be
conducted at 4–6 weeks of age for infants known to be
exposed to HIV, or at the earliest possible opportunity
for those seen after 4–6 weeks of birth. For children 12–
18 months of age, diagnosis using virological testing
is recommended. However, in resource-constrained
settings where access to virological testing is limited,
it is recommended that, for this age group, virological
tests be performed only after positive serological
testing. A definitive diagnosis of HIV in children aged
18 months or more (with known or unknown HIV
exposure) can be made with HIV serological tests,
including rapid serological tests following standard
testing algorithms used for adults.[45]
The Guidelines Group stressed that infants and
children living with HIV should routinely be screened
for TB as a part of standard clinical care, whether
they are receiving TB prophylaxis or ART. However,
the diagnosis of TB in children, with or without HIV, is
difficult and clinicians need a high index of suspicion
at all times and should follow national guidelines. A
history of contact of the infant or child with someone
with TB (regardless of the type of TB disease) within
the home is particularly important and should motivate
the health-care worker to screen for TB in the child
and among the other family members.
Based on this analysis and the relative lack of good
studies, the Guidelines Group concluded that the
quality of evidence is low and available data are
limited regarding the best approach to screening
infants and children for TB. The range of evidence
assessed using GRADE included a number of scoring
systems for children who are not infected with HIV.
However, such scoring systems were not found to be
as effective in children living with HIV (Annex 13).[46]
The evidence also included one unpublished study
that investigated a combination of signs and symptoms
to reliably exclude active TB in a child with HIV.