Patients with Bacteriologically Confirmed Pulmonary Tuberculosis (TB) in Children with HIV (Human Immunodeficiency Virus) on Anti-retroviral (ARV) Treatment
DOI:
https://doi.org/10.53089/medula.v14i10.1423Keywords:
Antiretrovirals, anti-tuberculosis drugs, human immunodeficiency virus, tuberculosisAbstract
Tuberculosis (TB) in children with Human Immunodeficiency Virus (HIV) is a complex clinical challenge due to the synergistic interaction between these two diseases, which mutually worsen the patient's clinical condition. HIV decreases immunity, thus increasing the risk of TB infection, while TB accelerates HIV progressivity. TB-HIV co-infection is a major cause of morbidity and mortality, especially in children with undetected M. Tuberculosis infection. By 2022, an estimated 710,000 HIV patients will develop TB, of which 187,000 will die. This article aims to provide an update on the management of pulmonary TB in children with HIV who are routinely on antiretroviral (ARV) treatment. The discussion covers the definition, epidemiology, etiology, disease progression, pathogenesis, diagnosis, supporting investigations, and management of TB-HIV. The diagnosis of TB in children with HIV is often difficult due to non-specific clinical manifestations and limitations of diagnostic tests. Therefore, early detection through comprehensive testing is essential. TB-HIV management requires a multidisciplinary approach, including appropriate TB treatment and integrated ARV administration. Intensive monitoring is also required to prevent complications, such as drug resistance or adverse effects of therapy. In conclusion, this article emphasizes the importance of a holistic approach in evaluating and managing pulmonary TB in children with HIV, including interprofessional collaboration, family education, and preventive efforts to improve patients' quality of life and reduce mortality.
References
World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed. Geneva: World Health Organization; 2016. ANNEX 10, WHO clinical staging of HIV disease in adults, adolescents and children.
Angel A, Vaillant J, Naik R. HIV-1–associated opportunistic infections. Treasure Island (FL): StatPearls Publishing; 2024.
Andrianto A, Mertaniasih NM, Gandi P, Al-Farabi MJ, Azmi Y, Jonatan M, Silahooij SI. Diagnostic test accuracy of Xpert MTB/RIF for tuberculous pericarditis: a systematic review and meta-analysis. 2020.
World Health Organization. WHO HIV report. Geneva (Switzerland): World Health Organization; 2022.
Kementerian Kesehatan Republik Indonesia, Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan. Rencana Aksi Nasional Kolaborasi TB-HIV 2015-2019. Jakarta: Kementerian Kesehatan Republik Indonesia; 2015.
Migliori GB, Thong PM, Alffenaar JW, Denholm J, Tadolini M, Alyaquobi F, et al. Gauging the impact of the COVID-19 pandemic on tuberculosis services: a global study. Eur Respir J. 2021;58(5):2101786.
Gupta A, Wood R, Kaplan R, Bekker LG, Lawn SD. Tuberculosis incidence rates during 8 years of follow-up of an antiretroviral treatment cohort in South Africa: comparison with rates in the community. PLoS One. 2012;7(3):e34156.
Petruccioli E, Scriba TJ, Petrone L, Hatherill M, Cirillo DM, Joosten SA, et al. Correlates of tuberculosis risk: predictive biomarkers for progression to active tuberculosis. Eur Respir J. 2016;48(6):1751-63.
Pai M, Behr MA, Dowdy D, Dheda K, Divangahi M, Boehme CC, et al. Tuberculosis. Nat Rev Dis Primers. 2016;2:16076.
Kementerian Kesehatan Republik Indonesia, Direktorat Jenderal Pencegahan dan Pengendalian Penyakit, Direktorat Pencegahan dan Pengendalian Penyakit Menular. Petunjuk teknis tata laksana tuberkulosis anak dan remaja. Jakarta: Kementerian Kesehatan Republik Indonesia; 2023.
Esmail H, Lai RP, Lesosky M, Wilkinson KA, Graham CM, Horswell S, et al. Complement pathway gene activation and rising circulating immune complexes characterize early disease in HIV-associated tuberculosis. Proc Natl Acad Sci U S A. 2018;115(10):E2320-7.
Moreira-Teixeira L, Mayer-Barber K, Sher A, O'Garra A. Type I interferons in tuberculosis: Foe and occasionally friend. J Exp Med. 2018;215(5):1273-85.
Migliori GB. The role of IGRA in the diagnosis of tuberculosis infection, differentiating from active tuberculosis, and decision making for initiating treatment or preventive therapy of tuberculosis infection. Int J Infect Dis. 2022;120:S29-30.
Geldmacher C, Schuetz A, Ngwenyama N, Casazza JP, Sanga E, Saathoff E, et al. Early depletion of Mycobacterium tuberculosis-specific T helper 1 cell responses after HIV-1 infection. J Infect Dis. 2008;198(11):1590-8.
Ronacher K, van Crevel R, Critchley JA, Bremer AA, Schlesinger LS, Kapur A, et al. Defining a research agenda to address the converging epidemics of tuberculosis and diabetes. Part 2: Underlying biologic mechanisms. Chest. 2017;152(1):174-80.
Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. National Institutes of Health, HIV Medicine Association, and Infectious Diseases Society of America; 2022.
Drain PK, Bajema KL, Dowdy D, et al. Incipient and subclinical tuberculosis: a clinical review of early stages and progression of infection. Clin Microbiol Rev. 2018;31(4):e00021-18.
Monkongdee P, McCarthy KD, Cain KP, et al. Yield of acid-fast smear and mycobacterial culture for tuberculosis diagnosis in people with human immunodeficiency virus. Am J Respir Crit Care Med. 2009;180(9):903-8.
Boehme CC, Nabeta P, Hillemann D, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010;363(11):1005-15.
Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N, et al. A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. Health Technol Assess. 2007;11(3):1-196.
Diedrich CR, O'Hern J, Gutierrez MG, et al. Relationship between HIV coinfection, interleukin 10 production, and Mycobacterium tuberculosis in human lymph node granulomas. J Infect Dis. 2016;214(9):1309-18.
Goletti D, Pisapia R, Fusco FM, Aiello A, Van Crevel R. Epidemiology, pathogenesis, clinical presentation and management of TB in patients with HIV and diabetes. Int J Tuberc Lung Dis. 2023;27(2):87-101.
Darraj MA. Pulmonary tuberculosis among HIV/AIDS patients: chest X-ray characteristics. 2020.
Kacprzak A, Oniszh K, Podlasin R, Marczak M, Cielniak I, Augustynowicz-Kopeć E, et al. Atypical pulmonary tuberculosis as the first manifestation of advanced HIV disease-diagnostic difficulties. Diagnostics (Basel). 2022;12(4):954.
Dybowska M, Błasińska K, Gątarek J, Klatt M, Augustynowicz-Kopeć E, et al. Tuberculous pericarditis—Own experiences and recent recommendations. Diagnostics (Basel). 2022;12(8):1980.
Yu G, Zhong F, Shen Y, Zheng H. Diagnostic accuracy of the Xpert MTB/RIF assay for tuberculous pericarditis: A protocol of systematic review and meta-analysis. PLoS One. 2021;16(3):e0248204.
National Institutes of Health, Centers for Disease Control and Prevention. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. HIV Medicine Association of the Infectious Diseases Society of America, Office of AIDS Research Advisory Council (OARAC); 2024.
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