TB and HIV: A Deadly Combination for Children

*ACTION asked Jen Pollakusky, a Senior Public Policy and Advocacy Officer at the Elizabeth Glaser Pediatric AIDS Foundation, to write a blog about current issues in childhood TB-HIV co-infection. The Foundation has a long history of advocating for child health and is a key ally in the fight against childhood TB-HIV.

by Jen Pollakusky, Elizabeth Glaser Pediatric AIDS Foundation

“It is unthinkable and grotesque that we make the same mistake over and over again.  There should be an uproar of children shouting, ‘What about me?’ But they often can’t speak and so their plight goes unnoticed until an outraged parent decides to speak out.” -Elizabeth Glaser, champion for children’s health and AIDS research

Thirty years ago, when scientists first discovered AIDS, fighting the disease in children was an afterthought. Today, children still lag behind in the fight against HIV and other infectious diseases, including childhood tuberculosis (TB).

As the leading cause of death among people living with HIV in sub-Saharan Africa, TB affects millions around the globe every year. HIV-positive children and women are among the hardest hit, often suffering from both HIV and TB - a potentially deadly combination, exacerbated by their weakened immune systems.

Despite this, TB in children remains a largely overlooked and neglected issue.

Currently, diagnosing TB in children remains a challenge and early detection of TB is difficult. Identifying TB is particularly difficult in children with HIV, who often have other pulmonary conditions that mimic the symptoms of TB. Children with HIV are also 20 times more likely to develop active TB than HIV-negative children and have a higher risk of dying of TB.

Like pediatric HIV, few medicines exist to treat TB in children, and there are more treatment options available for adults than children. Current methods of cutting adult tablets in half for use in children fall woefully short of adequately treating pediatric TB, and often prove difficult to administer to younger patients. Additional pediatric research and drug development are also urgently needed to improve TB treatment options for children.

Another important step in fighting TB in children is identifying TB in mothers.

Pregnant women with HIV are ten times more likely to contract TB, and those who have TB have a greater likelihood of passing HIV on to their infants during pregnancy, at birth, or during breastfeeding. Sadly, if infected, TB leads to a much higher mortality rate for both mothers and babies with HIV.

But TB rates among women and children with HIV can be greatly reduced by integrating TB services withexisting programs to prevent mother-to-child transmission (PMTCT) of HIV, as well as within broader maternal and child health services. The Elizabeth Glaser Pediatric AIDS Foundation is currently working to combine services for HIV and TB into one integrated package of care to improve the health of both mothers and children.

Working in partnership with the Ministry of Health and Social Welfare in Lesotho and John Hopkins University, the Foundation is studying the most effective ways to integrate HIV and TB services into maternal and child health clinics and PMTCT settings in Lesotho. As a first step to tackling the co-epidemics, this research will help strengthen medical guidelines and ultimately improve TB and HIV services for pregnant women.

In South Africa - which has the fourth highest number of TB cases worldwide - nurses like Sister Liza are doing their part to better identify women with TB and HIV. Sister Liza works with communities to raise awareness about HIV and TB, educate families about the dual diseases, follow-up with HIV-positive women and families who have missed their appointments, and visit patients at home to help deliver and administer medicines.

In Uganda, women living with HIV such as Kakazi are proof that integrating HIV and TB services is feasible - with successful results. Soon after learning she was HIV-positive, Kakazi developed a persistent cough. Because of her status, doctors tested Kakazi for TB. Her test results came back positive and she was immediately put on treatment.

Increasing screenings of HIV-positive pregnant women for TB and expanding TB testing to child immunization programs could help address HIV and TB co-infection in mothers and children. New TB diagnostic equipment, called Xpert MTB/RIF, significantly reduces the amount of time it takes to get TB test results back and increase the accuracy of those results - while also detecting more dangerous drug-resistant TB. While initial results show this new tool may be useful in diagnosing pediatric TB, more studies are needed.

More than twenty years ago, Elizabeth Glaser spoke out on behalf of children living with HIV and inspired policymakers to take action. Today, we have an important opportunity to follow Elizabeth’s example and advocate for children living with HIV and TB.

Let’s not make a mistake in failing to give children a voice. We must make fighting pediatric HIV and TB a priority.