CHILDHOOD HUMAN-IMMUNODEFICIENCY-VIRUS AND TUBERCULOSIS COINFECTIONS - RECONCILING CONFLICTING DATA

The impact of the human immunodeficiency virus (HIV) pandemic on child hood tuberculosis (TB) is unclear because of inconsistent and often co ntradictory findings in different types of studies. We review the evid ence which supports or refutes the likelihood that HIV infection in ch ildren predisposes them to TB, and conclude that, on balance, HIV duri ng infancy increases the risk of developing TB. Surveillance shows an association between rising TB rates among children and the HIV epidemi c in some parts of the world. A number of cross-sectional studies whic h have taken children with TB as their starting population, have yield ed high rates of association with HIV (11%-64% HIV prevalence). Simila rly, cross-sectional studies of hospitalised children with HIV show th at many also have TB. These rates of association are all over-estimate d because of the uncertainty of diagnosis of TB. Birth cohorts of peri natally HIV-infected infants and children prospectively followed up fo r a few years have generally failed to detect a higher incidence of TB than anticipated, The few TB cases identified in these cohorts were u sually over 15-18 months of age. In acute progressive lung disease the re is no excess of TB in HIV-infected over non HIV-infected children. These inconsistencies are discussed and attributed mainly to study des ign and statistical artefact. However, maternal factors in HIV-positiv e women which might affect transmission of TB to their babies are asse ssed, and infant immunoparesis due to HIV which may adversely influenc e resistance to TB is considered.