Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children
The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.
Last Updated: November 6, 2013; Last Reviewed: November 6, 2013
Detection of Latent TB Infection
Treatment for LTBI
Treatment of TB Disease
|Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials in children† with clinical outcomes and/or validated endpoints; I* = One or more randomized trials in adults with clinical outcomes and/or validated laboratory endpoints with accompanying data in children† from one or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; II = One or more well-designed, nonrandomized trials or observational cohort studies in children† with long-term outcomes; II* = One or more well-designed, nonrandomized trials or observational studies in adults with long-term clinical outcomes with accompanying data in children† from one or more similar nonrandomized trials or cohort studies with clinical outcome data; III = Expert opinion
†Studies that include children or children/adolescents, but not studies limited to post-pubertal adolescents
|Age/Weight||Combination Antiretroviral Therapy (cART)a
|Aged <3 years
or weight <10 kg
|Retain or Start the Following Regimens:
If Receiving NVP, Consider:
|Aged ≥3 years
and weight ≥10 kg
|Retain or Start the Following Regimens:
If Receiving EFV:
|Treatment for TB is not adjusted and should be initiated as soon as the diagnosis is made.
No cART adjustment is necessary with INH preventive therapy
|a TB patients newly diagnosed with HIV should receive cART as soon as possible, after completing the first 2 weeks of treatment for TB (earlier if clinically justified); efavirenz is preferred third drug with concurrent rifampin-based treatment for TB, but alternative options need to be considered in children aged <3 years and in those for whom efavirenz is not a preferred option.
b Children established on cART should be assessed for therapeutic failure. Do not exchange only a single drug in children whose viral load is not suppressed; rather, consider a full regimen change.
Adapted from Marais, Rabie, Cotton (2011)
Key to Acronyms: cART = combined antiretroviral therapy; EFV = efavirenz; NRTI = nucleoside reverse transcriptase inhibitor; NVP = nevirapine; TB = tuberculosis
|Indication||First Choice||Alternative||Comments/Special Issues|
|Source Case Drug Susceptible:
||Drug-drug interactions with cART should be considered for all rifamycin containing alternatives.
Intensive Phase (2 Months):
Note: Depends on disease entity
|Alternative for Rifampin:
If Good Adherence and Treatment Response:
If cART-naive, start TB therapy immediately and initiate cART within 2–8 weeks.
Already on cART; review to minimize potential toxicities and drug-drug interactions; start TB treatment immediately.
Potential drug toxicity and interactions should be reviewed at every visit.
|Key to Acronyms: cART = combined antiretroviral therapy; CNS = central nervous system; DOT = directly observed therapy; FDA = Food and Drug Administration; IGRA = interferon-gamma release assay; IM = intramuscular; IRIS = immune reconstitution inflammatory syndrome; IV = intravenous; MDR-TB = multi-drug-resistant tuberculosis; TB = tuberculosis; TST = tuberculin skin test
Pickering LK, Baker CJ, Kimberlin DW, Long SS, and the American Academy of Pediatrics. Tuberculosis. Red Book: 2009 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2009:680-701
Centers for Disease Control and Prevention. Tuberculin Testing and Treatment of Latent Tuberculosis Infection. MMWR 49(RR06);1-54. 2003.
Centers for Disease Control and Prevention. Treatment of Tuberculosis. MMWR 52(RR11);1-77. 2003.
Schaaf HS, Marais BJ. Management of multidrug-resistant tuberculosis in children: a survival guide for paediatricians. Paediatr Respir Rev. 2011; 12: 31-38
World Health Organization. Rapid Advice: treatment of tuberculosis in children. Paper presented at Geneva, Switzerland: (WHO/HTM/TB/2010.13).
World Health Organization. Guidance for national tuberculosis and HIV programmes on the management of tuberculosis in HIV-infected children: recommendations for a public health approach. Paper presented at: Paris, France: IUATLD , 2010