HIV and Tuberculosis Co-Infection in Pediatric Populations

Children living with HIV face a markedly increased risk of developing active tuberculosis owing to HIV-induced impairment of cell-mediated immunity. In paediatric populations, HIV accelerates progression from Mycobacterium tuberculosis infection to disease, exacerbates malnutrition and anaemia, and compounds diagnostic challenges arising from paucibacillary presentations. Clinical manifestations often overlap, with respiratory symptoms, failure to thrive and extrapulmonary involvement. Immunological markers such as declining CD4 counts and elevated viral loads correlate with higher tuberculosis incidence and poorer outcomes. Early initiation of antiretroviral therapy (ART) reduces tuberculosis risk by restoring immune function, yet timing must balance the risk of immune reconstitution inflammatory syndrome against untreated HIV progression. Preventive strategies including isoniazid preventive therapy and cotrimoxazole prophylaxis have demonstrated efficacy in reducing incident tuberculosis, although uptake remains suboptimal in many high-burden settings. Nutritional support, age-appropriate formulations and integrated HIV–TB care models are essential to improve survival and treatment success. Globally, paediatric HIV–TB co-infection remains a critical public health concern, particularly in sub-Saharan Africa and parts of Asia, where tuberculosis transmission is intense and healthcare access is variable.

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HIV and Tuberculosis Co-Infection in Pediatric Populations publication trend

The graph below shows the total number of articles in hiv and tuberculosis co-infection in pediatric populations across all publications each year (not limited to Nature Index journals).

Technical terms

Antiretroviral therapy (ART): Combination of drugs used to suppress HIV replication and restore immune function.

CD4 count: Measurement of a subtype of white blood cell targeted by HIV, indicative of immune competence.

Isoniazid preventive therapy (IPT): Short-course antibiotic regimen given to prevent activation of latent tuberculosis infection.

Cotrimoxazole preventive therapy (CPT): Prophylactic antibiotic combination that reduces opportunistic infections, including certain bacterial and protozoal diseases, and may lower tuberculosis risk.

Paucibacillary disease: Form of tuberculosis with low bacterial load, common in children, which complicates microbiological confirmation.

References

1. Clinical Outcomes in Children With Human Immunodeficiency Virus Treated for Nonsevere Tuberculosis in the SHINE Trial. Clinical Infectious Diseases (2024).
2. Epidemiology of childhood tuberculosis and predictors of death among children on tuberculosis treatment in central Ethiopia: an extended Cox model challenged survival analysis. BMC Public Health (2023).
3. The impact of HIV and antiretroviral therapy on TB risk in children: a systematic review and meta-analysis. Thorax (2017).