Skip to main content

Tuberculosis and Other Opportunistic Infections in HIV-Infected Children

  • Chapter
  • First Online:
Book cover Viral Infections in Children, Volume I
  • 518 Accesses

Abstract

Tuberculosis (TB) is the number one infectious disease killer on the planet and children living in human immunodeficiency virus (HIV)-affected households are particularly vulnerable. These children are at increased risk of TB exposure, given the high rates of TB among HIV-infected adults, and those who are very young or have HIV-induced immune compromise are at increased risk of progression to active disease. Apart from TB, HIV-infected children have increased susceptibility to a variety of other infections. Common infections such as viral and bacterial pneumonia occur with increased frequency and severity. They are also prone to opportunistic infections, which refer to organisms with low pathogenic potential that mainly cause disease in people with immune compromise. The main focus of this chapter is on tuberculosis and other opportunistic infections in HIV-infected children.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bates M, Mudenda V, Mwaba P, Zumla A. Deaths due to respiratory tract infections in Africa: a review of autopsy studies. Curr Opin Pulm Med. 2013;19:229–37.

    Article  PubMed  Google Scholar 

  2. Gupta RK, Lucas SB, Fielding KL, Lawn SD. Prevalence of tuberculosis in post-mortem studies of HIV infected adults and children in resource-limited settings: a systematic review and meta-analysis. AIDS. 2015;29:1987–2002.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Venturini E, Turkova A, Chiappini E, Galli L, de Martino M, Thorne C. Tuberculosis and HIV co-infection in children. BMC Infect Dis. 2014;14(Suppl 1):S5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Violari A, Cotton MF, Gibb DM, et al. Early antiretroviral therapy and mortality among HIV infected infants. N Engl J Med. 2008;359:2233–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: World Health Organization; 2016. http://apps.who.int/iris/handle/10665/208825

  6. Boulware DR, Callens S, Pahwa S. Pediatric HIV immune reconstitution inflammatory syndrome. Curr Opin HIV AIDS. 2008;3:461–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. B-Lajoie MR, Drouin O, Bartlett G, et al. Incidence and prevalence of opportunistic and other infections and the impact of antiretroviral therapy among HIV-infected children in low- and middle-income countries: a systematic review and meta-analysis. Clin Infect Dis. 2016;62:1586–94.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nesheim SR, Kapogiannis BG, Soe MM, et al. Trends in opportunistic infections in the pre- and post-highly active antiretroviral therapy eras among HIV-infected children in the Perinatal AIDS Collaborative Transmission Study, 1986-2004. Pediatrics. 2007;120:100–9.

    Article  PubMed  Google Scholar 

  9. Dankner WM, Lindsey JC, Levin MJ, Pediatric ACTGPT. Correlates of opportunistic infections in children infected with the human immunodeficiency virus managed before highly active antiretroviral therapy. Pediatr Infect Dis J. 2001;20:40–8.

    Article  CAS  PubMed  Google Scholar 

  10. Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children. Department of Health and Human Services. http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf

  11. Wolf ER, Beste S, Barr E, Wallace J, et al. Health outcomes of international HIV-infected adoptees in the United States. Pediatr Infect Dis J. 2016;35:422–7.

    Article  PubMed  Google Scholar 

  12. World Health Organization. Global tuberculosis report 2015. WHO/HTM/TB/2015.

    Google Scholar 

  13. Marais BJ, Gupta A, Starke JR, El Sony A. Tuberculosis in women and children. Lancet. 2010;375:2057–9.

    Article  PubMed  Google Scholar 

  14. Lawn SD, Bekker LG, Middelkoop K, Myer L, Wood R. Impact of HIV infection on the epidemiology of tuberculosis in a peri-urban community in South Africa: the need for age-specific interventions. Clin Infect Dis. 2006;42:1040–7.

    Article  PubMed  Google Scholar 

  15. Wood R, Johnstone-Robertson S, Uys P, et al. Tuberculosis transmission to young children in a South African community: modeling household and community infection risks. Clin Infect Dis. 2010;51:401–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cotton MF, Schaaf HS, Lottering G, Weber HL, Coetzee J, Nachman S. Tuberculosis exposure in HIV-exposed infants in a high-prevalence setting. Int J Tuberc Lung Dis. 2008;12:225–7.

    CAS  PubMed  Google Scholar 

  17. Hesseling AC, Cotton MF, Jennings T, et al. High incidence of tuberculosis among HIV-infected infants: evidence from a South African population-based study highlights the need for improved tuberculosis control strategies. Clin Infect Dis. 2009;48:10.

    Article  Google Scholar 

  18. Gupta A, Bhosale R, Kinikar A, et al. Maternal tuberculosis: a risk factor for mother-to-child transmission of human immunodeficiency virus. J Infect Dis. 2011;203:358–63.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Marais BJ, Seddon JA, Detjen AK, et al. Interrupted BCG vaccination is a major threat to global child health. Lancet Respir Med. 2016;4:251–3.

    Article  PubMed  Google Scholar 

  20. Fordham von Reyn C. Routine childhood Bacille Calmette Guerin immunization and HIV infection. Clin Infect Dis. 2006;42:559–61.

    Article  PubMed  Google Scholar 

  21. Hesseling AC, Rabie H, Marais BJ, et al. Bacille Calmette-Guerin (BCG) vaccine-induced complications and HIV infection in children. Clin Infect Dis. 2006;42:548–58.

    Article  CAS  PubMed  Google Scholar 

  22. Hesseling AC, Cotton MF, Marais BJ, et al. BCG and HIV reconsidered: moving the research agenda forward. Vaccine. 2007;25:6565–8.

    Article  CAS  PubMed  Google Scholar 

  23. Hessling AC, Cotton MF, Fordham von Reyn C, Graham SM, Gie RP, Hussey GD. Consensus statement on the revised World Health Organization recommendations for BCG vaccination in HIV-infected infants. Int J Tuberc Lung Dis. 2008;12:1376–9.

    Google Scholar 

  24. Walters E, Cotton MF, Rabie H, Schaaf HS, Walters LO, Marais BJ. Clinical presentation and outcome of tuberculosis in human immunodeficiency virus infected children on antiretroviral therapy. BMC Pediatr. 2008;8:1.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Dangor Z, Izu A, Hillier K, et al. Impact of the antiretroviral treatment program on the burden of hospitalization for culture-confirmed tuberculosis in South African Children: a time-series analysis. Pediatr Infect Dis J. 2013;32:972–7.

    Article  PubMed  Google Scholar 

  26. UNAIDS. 90–90–90 An ambitious treatment target to help end the AIDS epidemic. UNAIDS/JC2684; 2014.

    Google Scholar 

  27. Marais BJ, Ayles H, Graham SM, Godfrey-Faussett P. Screening and preventive therapy for tuberculosis. Clin Chest Med. 2009;30:827–46.

    Article  PubMed  Google Scholar 

  28. Zar HJ, Cotton MF, Strauss S, et al. Effect of isoniazid prophylaxis on mortality and incidence of tuberculosis in children with HIV: randomised controlled trial. BMJ. 2007;334:136.

    Article  CAS  PubMed  Google Scholar 

  29. Frigati LJ, Kranzer K, Cotton MF, et al. The impact of isoniazid preventive therapy and antiretroviral therapy on tuberculosis in children infected with HIV in a high tuberculosis incidence setting. Thorax. 2011;66:496–501.

    Article  CAS  PubMed  Google Scholar 

  30. Madhi SA, Nachman S, Violari A, et al. Effect of primary isoniazid prophylaxis against tuberculosis in HIV-exposed children. N Engl J Med. 2011;365:21–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Crook AM, Turkova A, Musiime V, et al. Tuberculosis incidence is high in HIV infected African children but is reduced by co-trimoxazole and time on antiretroviral therapy. BMC Med. 2016;14:50.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Marais BJ, Graham SM, Cotton MF, Beyers N. Diagnostic and management challenges of childhood TB in the era of HIV. J Infect Dis. 2007;196(Suppl 1):S76–85.

    Article  PubMed  Google Scholar 

  33. Marais BJ, Gie RP, Schaaf HS, et al. A refined symptom-based approach to diagnose pulmonary tuberculosis in children. Pediatrics. 2006:e1350–9.

    Google Scholar 

  34. Moore DP, Klugman KP, Madhi SA. Role of Streptococcus pneumoniae in hospitalization for acute community-acquired pneumonia associated with culture-confirmed Mycobacterium tuberculosis in children: a pneumococcal conjugate vaccine probe study. Pediatr Infect Dis J. 2010;29:1099–104.

    Article  PubMed  Google Scholar 

  35. Marais BJ, Gie RP, Schaaf HS, et al. The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis. 2004;8:392–402.

    CAS  PubMed  Google Scholar 

  36. Perez-Velez CM, Marais BJ. Tuberculosis in children. N Engl J Med. 2012;367:348–61.

    Article  CAS  PubMed  Google Scholar 

  37. Roya-Pabon CL, Perez-Velez CM. Tuberculosis exposure, infection and disease in children: a systematic diagnostic approach. BMC Pneumonia 2016;8:23.

    Google Scholar 

  38. Marais BJ, Pai M. New approaches and emerging technologies in the diagnosis of childhood tuberculosis. Paediatr Respir Rev. 2007;8:124–33.

    Article  PubMed  Google Scholar 

  39. Schaaf HS, Krook S, Hollemans DW, et al. Recurrent culture-confirmed tuberculosis in human immunodeficiency-virus infected children. Pediatr Infect Dis. 2005;24:685–91.

    Article  Google Scholar 

  40. Marais B. The global tuberculosis situation and the inexorable rise of drug-resistant disease. Adv Drug Deliv Rev. 2016;102:3–9.

    Article  CAS  PubMed  Google Scholar 

  41. Schaaf HS, Marais BJ. Management of multidrug-resistant tuberculosis in children: a survival guide for paediatricians. Paediatr Respir Rev. 2011;12(3):1–8.

    Google Scholar 

  42. Isaakidis P, Casas EC, Das M, Tseretopoulou X, Ntzani EE, Ford N. Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis. Int J Tuberc Lung Dis. 2015;19:969–78.

    Article  CAS  PubMed  Google Scholar 

  43. Rabie H, Gousaard P. Tuberculosis and pneumonia in HIV infected children, an overview. Pneumonia. 2016;8:19.

    Article  Google Scholar 

  44. Meintjes G, Rabie H, Wilkinson RJ, Cotton MF. Tuberculosis-associated immune reconstitution inflammatory syndrome and unmasking of tuberculosis by antiretroviral therapy. Clin Chest Med. 2009;30:797–810.

    Article  PubMed  Google Scholar 

  45. Link-Gelles R, Moultrie H, Sawry S, Murdoch D, Van Rie A. Tuberculosis immune reconstitution inflammatory syndrome in children initiating antiretroviral therapy for HIV infection: a systematic literature review. Pediatr Infect Dis J. 2014;33:499–503.

    Article  PubMed  PubMed Central  Google Scholar 

  46. van Toorn R, Rabie H, Dramowski A, Schoeman JF. Neurological manifestations of TB-IRIS: a report of 4 children. Eur J Paediatr Neurol. 2012;16:676–82.

    Article  PubMed  Google Scholar 

  47. Chintu C, Bhat GJ, Walker AS, et al. Co-trimoxazole as prophylaxis against opportunistic infections in HIV infected Zambian children (CHAP): a double-blind randomised placebo-controlled trial. Lancet. 2004;364:1865–71.

    Article  CAS  PubMed  Google Scholar 

  48. Morrow BM, Samuel CM, Zampoli M, Whitelaw A, Zar HJ. Pneumocystis pneumonia in South African children diagnosed by molecular methods. BMC Res Notes. 2014;7:26.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Graham SM, Mtitimila EI, Kamanga HS, Walsh AL, Hart CA, Molyneux ME. Clinical presentation and outcome of Pneumocystis carinii pneumonia in Malawian children. Lancet 2000; 355:369–73.

    Google Scholar 

  50. Pitcher RD, Daya R, Beningfield SJ, Zar HJ. Chest radiographic presenting features and radiographic progression of pneumocystis pneumonia in South African children. Pediatr Pulmonol. 2011;46:1015–22.

    Article  PubMed  Google Scholar 

  51. Zar HJ, Langdon G, Apolles P, et al. Oral trimethoprim-sulphamethoxazole levels in stable HIV-infected children. S Afr Med J. 2006;96:627–9.

    CAS  PubMed  Google Scholar 

  52. Mankahla A, Mosam A. Common skin conditions in children with HIV/AIDS. Am J Clin Dermatol. 2012;13:153–66.

    Article  PubMed  Google Scholar 

  53. Guidelines on the Treatment of Skin and Oral HIV-Associated Conditions in Children and Adults. Geneva: World Health Organization; 2014.

    Google Scholar 

  54. Van der Wouden JC, van der Sande R, van Suijlekom-Smit LWA, et al. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2009;7(4):CD004767.

    Google Scholar 

  55. Jones V, Smith SJ, Omar HA. Nonsexual transmission of anogenital warts in children: a retrospective analysis. Scientific World Journal. 2007;7:1896–9.

    Article  PubMed  Google Scholar 

  56. Moscicki AB, Farhat S, Yao TJ, Ryder MI, et al. Oral human papillomavirus in youth from the pediatric HIV/AIDS cohort study. Sex Transm Dis. 2016;43:498–500.

    Article  PubMed  Google Scholar 

  57. Levin MJ, Moscicki AB, Song LY, et al. Safety and immunogenicity of a quadrivalent human papillomavirus (types 6, 11,16, and 18) vaccine in HIV-infected children 7 to 12 years old. J Acquir Immune Defic Syndr. 2010;55(2):197–204.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Weinberg A, Song LY, Saah A, et al. Humoral, mucosal and cell-mediated immunity against vaccine and non-vaccine genotypes after administration of quadrivalent human papillomavirus vaccine to HIV-infected children. J Infect Dis. 2012;206:1309–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Jura E, Chadwick EG, Josephs SH, et al. Varicella-zoster virus infections in children infected with human immunodeficiency virus. Pediatr Infect Dis J. 1989;8:586–90.

    Article  CAS  PubMed  Google Scholar 

  60. Srugo I, Israele V, Wittek AE, et al. Clinical manifestations of varicella-zoster virus infections in human immunodeficiency virus-infected children. Am J Dis Child. 1993;147:742–5.

    CAS  PubMed  Google Scholar 

  61. Wood SM, Shah SS, Steenhoff AP, Rutstein RM. Primary varicella and herpes zoster among HIV-infected children from 1989 to 2006. Pediatrics. 2008;121:e150–6.

    Article  PubMed  Google Scholar 

  62. Kao C, Goldman DL. Cryptococcal disease in HIV-infected children. Curr Infect Dis Rep. 2016;18:27.

    Article  PubMed  Google Scholar 

  63. Meiring ST, Quan VC, Cohen C, et al. A comparison of pediatric- and adult-onset cryptococcosis detected through population surveillance in South Africa, 2005–2007. AIDS. 2012;26:2307–14.

    Article  PubMed  Google Scholar 

  64. WHO. Rapid advice: diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children. 2011. http://www.who.int/hiv/pub/cryptococcal_disease2011/en/

  65. Beardsley J, Wolbers M, Kibengo FM, Ggayi AB, et al. Adjunctive dexamethasone in HIV-associated cryptococcal meningitis. N Engl J Med. 2016;374:542–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Beardsley J, Wolbers M, Day JN, CrptoDex Investigators. Dexamethasone in cryptococcal meningitis. N Engl J Med. 2016;375:189–90.

    PubMed  Google Scholar 

  67. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children: Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Department of Health and Human Services. http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf

  68. Schwenk H, Ramirez-Avila L, Sheu SH, et al. Progressive multifocal leukoencephalopathy in pediatric patients: case report and literature review. Pediatr Infect Dis J. 2014;33(4):e99–105.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Chang Y, Cesarman E, Pessin MS, Lee F, Culpepper J, Knowles DM, Moore PS. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi’s sarcoma. Science. 1994;266:1865.

    Article  CAS  PubMed  Google Scholar 

  70. Orem J, Otieno MW, Remick SC. AIDS-associated cancer in developing nations. Curr Opin Oncol. 2004;16:468.

    Article  PubMed  Google Scholar 

  71. Gantt S, Orem J, Krantz EM, Morrow RA, et al. Prospective characterization of the risk factors for transmission and symptoms of primary human herpesvirus infections among Ugandan infants. J Infect Dis. 2016;214:36.

    Article  PubMed  Google Scholar 

  72. Butler LM, Were WA, Balinandi S, Downing R, et al. Human herpesvirus 8 infection in children and adults in a population-based study in rural Uganda. J Infect Dis. 2011;203:625.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Rohner E, Wyss N, Heg Z, et al. HIV and human herpesvirus 8 co-infection across the globe: systematic review and meta-analysis. Int J Cancer. 2016;138:45–54.

    Article  CAS  PubMed  Google Scholar 

  74. Bohlius J, Maxwell N, Spoerri A, Wainwright R, et al. Incidence of AIDS-defining and other cancers in HIV-positive children in South Africa: record linkage study. Pediatr Infect Dis J. 2016;35:e164–70.

    Article  PubMed  Google Scholar 

  75. Rohner E, Valeri F, Maskew M, Prozesky H, et al. Incidence rate of Kaposi sarcoma in HIV-infected patients on antiretroviral therapy in Southern Africa: a prospective multicohort study. J Acquir Immune Defic Syndr. 2014;67:547–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Luppi M, Barozzi P, Rasini V, et al. Severe pancytopenia and hemophagocytosis after HHV-8 primary infection in a renal transplant patient successfully treated with foscarnet. Transplantation. 2002;74:131–2.

    Article  PubMed  Google Scholar 

  77. Vaz P, Macassa E, Jani I, et al. Treatment of Kaposi sarcoma in human immunodeficiency virus-1-infected Mozambican children with antiretroviral drugs and chemotherapy. Pediatr Infect Dis J. 2011;30:891–3.

    Article  PubMed  Google Scholar 

  78. World Health Organization. Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults. Geneva; 2014.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ben J. Marais .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Rabie, H., Marais, B.J. (2017). Tuberculosis and Other Opportunistic Infections in HIV-Infected Children. In: Green, R. (eds) Viral Infections in Children, Volume I. Springer, Cham. https://doi.org/10.1007/978-3-319-54033-7_4

Download citation

Publish with us

Policies and ethics