Unlike the screening rule for adults and

Unlike the screening rule for adults and
adolescents, this recommendation is based on expert
opinion and clinicians need to broaden the differential
diagnosis to include other diseases that may cause
children with HIV to present with current cough, fever
and poor weight gain. Similarly, contact history with a
known TB case should raise the clinical suspicion of
TB in children living with HIV.
The Guidelines Group recommends that children
living with HIV without poor weight gain, fever and
current cough are unlikely to have active TB and
should be offered IPT (see below for age-specific
recommendations). Similarly, children living with HIV
with any one of the following symptoms – poor weight
gain, fever, current cough and contact with a TB case
– may have TB and should be evaluated for TB and
other diseases. If the evaluation shows no TB, such
children should be offered IPT regardless of their ageTwo studies were considered for the GRADE
assessment of the evidence (Annex 14). One
study suggested considerable benefits for children
receiving INH for six months, in particular, with
regard to significant reductions in mortality.[49]
However, findings from a randomized control
trial conducted in South Africa showed that when
HIV-infected infants with no known exposure to a
TB source case are identified in the first three to
four months of life, given rapid access to ART and
carefully monitored for new TB exposure or disease
on a monthly basis, there is no benefit from IPT
(Madhi 2008, unpublished).Therefore, based on this, the Guidelines Group
recommends that all children living with HIV who are
more than 12 months of age and who are unlikely
to have active TB should receive six months of IPT
as part of a comprehensive package of HIV care.
For those children less than 12 months of age,
only those who have been evaluated for TB (using
investigations) should receive six months IPT if the
evaluation shows no TB disease. In contrast to adults
and adolescents, there is no evidence to support the
use of INH for longer than six months in children.
Therefore, the Guidelines Group concluded that until
more data are available, INH for children could not