TB Manual

All children diagnosed with TB should be screened for HIV and all children diagnosed with HIV should be screened for TB at time of diagnosis of both. Children should be rescreened only if there are new exposures. Early antiretroviral therapy soon after diagnosis is now recommended for all children with HIV. The interactions between antiretroviral therapy and TB treatment are therefore important considerations in TB management.⁹¹

Given the numerous drug interactions between TB treatment and antiretroviral therapy, all cases of TB disease should be referred to a pediatric HIV center of expertise.⁹² With the exception of CNS TB, antiretroviral therapy should ideally be initiated within 2 weeks of TB treatment being established. However, given the challenges of administering pediatric formulations of both TB drugs and antiretroviral therapy (taste and volume of multiple liquid suspensions), drug interactions and overlapping toxicities, delaying antiretroviral therapy for up to 8 weeks after TB treatment is initiated is reasonable for children without advanced HIV disease; in cases of CNS TB, a delay of at least 4 weeks is recommended for antiretroviral therapy initiation (see Chapter 10: Treatment of Active Tuberculosis in Special Populations). DOT should be used in these cases for the duration of TB treatment.⁹³

Good practice statement

• HIV-positive children who are treated for TB disease should have close adherence monitoring, (ie, directly observed therapy) for the entire duration of treatment.

Switch To: Français