Dr Havlir said that, "Children have more rapid progression of TB from infection to disease as compared to adults. TB diagnosis is more difficult in children than adults. TB/ART dosing is more complex and cascade of care is more challenging. The way forward is to prevent all parent-to-child transmission of HIV; start ART in all HIV-positive children and put all children exposed to TB cases on IPT. One study has shown an 8.8-fold increase in deaths in those children not starting ART compared to those stating ART within 2 months of TB diagnosis."
Dr Steve Graham, lead author of the WHO Guidance on Childhood TB and Childhood TB Roadmap, told CNS that, "Study from Thailand shows that children who are living with HIV and also get TB have a much poorer survival curve than those children who do not get TB. Studies from Vietnam show that giving IPT and ART to children living with HIV give much better result in terms of child health and child survival. After Childhood TB Roadmap, we are trying to get a better handle on TB and TB-HIV in adolescents, which is another neglected area."
There is an urgent need for more research to have better point of care diagnostics and simpler, shorter drug regimens for all forms of TB. But till then, Dr Havlir appealed for monitoring and fixing the HIV/TB care cascade with the existing tools. Early diagnosis of TB in PLHIV and early start of ART (within 2 weeks of diagnosis) in PLHIV diagnosed with TB along with TB treatment will go a long way to stem the tide of TB-related deaths in people living with HIV.
Shobha Shukla, CNS
(The author is the Managing Editor of CNS. She is reporting from the XX International AIDS Conference (AIDS 2014) with support from the World Health Organization (WHO) Global Tuberculosis Programme. She is a J2J Fellow of National Press Foundation (NPF) USA and received her editing training in Singapore. She has earlier worked with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored and edited publications on gender justice, childhood TB, childhood pneumonia, Hepatitis C Virus and HIV, and MDR-TB. Email: shobha@citizen-news.org, website: www.citizen-news.org)
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