TB/HIV: a clinical manual - libdoc.who.int - World Health Organization

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HIV-related TB in childrenAs in adults, the natural history of TB in a child infected with HIVdepends on the stage of HIV disease. Early in HIV infection, whenimmunity is good, the signs of TB are similar to those in a child withoutHIV infection. As HIV infection progresses and immunity declines,dissemination of TB becomes more common. Tuberculous meningitis,miliary TB, and widespread tuberculous lymphadenopathy occur.I1.3.7 Impact of TB on HIVIn an individual infected with HIV, the presence of other infections,including TB, may allow HIV to multiply more quickly.This may result inmore rapid progression of HIV disease.SUGGESTIONS FOR FURTHER READINGTUBERCULOSISCrofton J, Horne N, Miller F. Clinical tuberculosis. Second edition. London,MacMillan Press Limited, 1999.Schlossberg D, ed: Tuberculosis and nontuberculous mycobacterial infections.Fourth edition. Philadelphia,WB Saunders, 1998.International Union Against Tuberculosis and Lung Disease. Tuberculosis guidefor low income countries. Fifth edition. Paris, 2000.Reider HL. Epidemiologic basis of tuberculosis control. Paris, International UnionAgainst Tuberculosis and Lung Disease, 1999.World Health Organization. Tuberculosis handbook. Geneva, 1998(WHO/TB/98.253).World Health Organization. Global tuberculosis control: surveillance, planning,financing. WHO report 2003. Geneva, 2003 (WHO/CDS/TB/2003.316).HIV/AIDSFauci AS.The AIDS epidemic. Considerations for the 21st century.New England Journal of Medicine, 1999, 341: 1046–1050.Royce RA, Sena A, Cates Jr, W Cohen, MS. Sexual transmission of HIV.New England Journal of Medicine, 1997, 336: 1072–1078.TB/HIV:A CLINICAL MANUAL39
World AIDS series. Lancet, 2000, 355: WA1–WA40.Joint United Nations Programme on HIV/AIDS (UNAIDS). Report on the globalHIV/AIDS epidemic: July 2002. Geneva, (contains country-specific estimates).Joint United Nations Programme on HIV/AIDS (UNAIDS). AIDS epidemicupdate: December 2002. Geneva, 2002.CLINICAL STAGING SYSTEM FOR HIV AND HIV-RELATEDDISEASEWorld Health Organization. Scaling up antiretroviral therapy in resource-limitedsettings. Guidelines for a public health approach. Geneva, 2002.AIDS CASE DEFINITIONS FOR SURVEILLANCEAcquired immunodeficiency syndrome (AIDS).WHO/CDC case definition forAIDS. Weekly epidemiological record, 1986, 61: 69–73. (WHO clinical casedefinitions for AIDS in children where HIV testing is not available).Centers for Disease Control and Prevention. 1994 revised classification systemfor human immunodeficiency virus infection in children less than 13 years ofage. Morbidity and mortality weekly report, 1994; 43 (No. RR-12): 1-10. (Casedefinition for AIDS in children where HIV testing is available).WHO case definitions for AIDS surveillance in adults and adolescents. Weeklyepidemiological record 1994, 69: 273-275.HIV-RELATED TUBERCULOSISCorbett EL,Watt CJ,Walker N, Maher D, Williams BG, Raviglione MC, Dye C.The growing burden of tuberculosis: global trends and interactions with theHIV epidemic. Archives of internal medicine, 2003, 163: 1009–1021.Raviglione MC, Harries AD, Msiska R, Wilkinson D, Nunn P. Tuberculosis andHIV: current status in Africa. AIDS, 1997, 11 (suppl B): S115 - S123.Ya Diul M, Maher D, Harries A. Tuberculosis case fatality rates in high HIVprevalence populations in sub-Saharan Africa. AIDS, 2001, 15: 143-152.World Health Organization. A strategic framework to decrease the burden ofTB/HIV. Geneva, 2002 (WHO/CDS/TB/2002.296;WHO/HIV_AIDS/2002.2).World Health Organization. Guidelines for collaborative TB and HIV programmeactivities. Geneva, 2003, (WHO/CDS/TB/2003.319;WHO/HIV/2003.01).40BACKGROUND INFORMATION ON TB AND HIV
Page 1 and 2: WHO/HTM/TB/2004.329TB HIVA CLINICAL
Page 3 and 4: WHO Library Cataloguing-in-Publicat
Page 5 and 6: 2.2.4 Key operations for DOTS imple
Page 7 and 8: 9.4 TB treatment regimens: question
Page 9 and 10: 12.7 Neurological problems in adult
Page 12 and 13: FOREWORD TO SECOND EDITIONWHO is co
Page 14 and 15: PREFACE TO SECOND EDITIONRecognitio
Page 16 and 17: GLOSSARY AND ABBREVIATIONSThis glos
Page 18 and 19: HIV-negativeHIV-positiveHIV-related
Page 20: RNARTISCCscrofulasensitivity testse
Page 24 and 25: BACKGROUND INFORMATION ONTUBERCULOS
Page 26 and 27: dead, 25% will be healthy (self-cur
Page 28 and 29: smear; upper lobe involvement; usua
Page 30 and 31: About one-third of children born to
Page 32 and 33: important cells in the cell-mediate
Page 34 and 35: AdultsWHO clinical staging system f
Page 36 and 37: 1.2.8 Epidemiological surveillance
Page 38 and 39: 1.3.2 HIV infection and risk of TBH
Page 42 and 43: AN EXPANDED FRAMEWORK FOR EFFECTIVE
Page 44 and 45: 2.2.3 TB control policy package (th
Page 46 and 47: º Undertake economic analysis and
Page 48 and 49: 2.5 DOTS-PLUSHigh levels of multidr
Page 50 and 51: DIAGNOSIS OF PULMONARY TUBERCULOSIS
Page 52 and 53: 3.3 DIAGNOSTIC SPUTUM SMEAR MICROSC
Page 54 and 55: Sensitivity of sputum smear microsc
Page 56 and 57: PRACTICAL POINTIf the patient is br
Page 58 and 59: cavitationunilateral infiltrationbi
Page 60 and 61: Clinical and CXR features of PCP an
Page 62 and 63: DIAGNOSIS OF PULMONARY TUBERCULOSIS
Page 64 and 65: disease to other parts of the body,
Page 66 and 67: (3) Respiratory symptoms such as co
Page 68 and 69: º evidence of wasting (i.e. under
Page 70 and 71: In the past, some doctors have advo
Page 72 and 73: productive of copious purulent and
Page 74 and 75: distinguishing TB-infected from non
Page 76 and 77: DIAGNOSIS OF EXTRAPULMONARYTUBERCUL
Page 78 and 79: Practical approach to investigation
Page 80 and 81: Clinical differentiation of miliary
Page 82 and 83: malignancy, post-pneumonic effusion
Page 84 and 85: Therapeutic pericardiocentesis is n
Page 86 and 87: Clinical featuresThe patient may pr
Page 88 and 89: 5.6 OTHER FORMS OF EXTRAPULMONARY T
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SUGGESTIONS FOR FURTHER READINGCrof
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PRACTICAL POINTFull blood count (FB
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countries for staging and monitorin
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provides support. Counselling is a
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SUGGESTIONS FOR FURTHER READINGUNAI
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Lesscommonextensive fungal skin, na
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positive. These include the poor ou
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STANDARDIZED TUBERCULOSIS CASEDEFIN
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Pulmonary TB - sputum smear-negativ
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The table below shows the severe an
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First-line Mode of Potency Recommen
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growing bacilli and the killing of
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Recommended treatment regimens for
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9.4 TB TREATMENT REGIMENS: QUESTION
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9.5 USE OF ANTI-TB DRUGS IN SPECIAL
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PRACTICAL POINTRecording treatment
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indicators are treatment completion
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SCCAmong TB patients who complete S
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SIDE-EFFECTS OF ANTI-TUBERCULOSIS D
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PRACTICAL POINTRifampicin reduces t
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10.7.1 Treatment regimen includes t
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not a severe reaction) to isoniazid
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ANTIRETROVIRAL THERAPY FOR THETREAT
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eplication and functioning of HIV.
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18 HIV antibody º WHO Paediatric S
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Name of drug Formulations Pharmacok
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Stavudine Maximum dose: Needs to be
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Efavirenz 25 to 33 kg: 350 mg(EFZ)
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11.7 CHOICE OF ART REGIMENWHO recom
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Recommended first-line ARV combinat
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11.10 INTERACTIONS BETWEEN ARV DRUG
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SUGGESTIONS FOR FURTHER READINGBart
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worldwide. There has also been rece
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chlamydia doxycycline 100 mg orally
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º Fungal infectionsInfection Local
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Ichthyosis(dry scalyskin)PsoriasisE
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sputuminductionusing 3-5%hypertonic
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Where available, barium swallow sho
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Isospora bellitrimethoprim 80 mg/su
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Always check a blood film for malar
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It is unlikely, but possible, that
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a variety of neurological problems
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section 12.4 on skin problems), a b
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ChildrenIn children with known or s
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PathogenPneumocystis cariniiDrug re
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COORDINATED CARE IN DIFFERENT SETTI
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º access to voluntary counselling
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13.5.3 Secondary careMeasures appli
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Secondary care As for primary As pe
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SUGGESTIONS FOR FURTHER READINGGilk
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PRACTICAL POINTIn wards, outpatient
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14.3.2 BCG protection against TB in
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) Aimed at decreasing risk of a rec
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to exclude active TB and to ensure
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SUGGESTIONS FOR FURTHER READINGHarr
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Childrenapproach to TB diagnosis .
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Kaposi sarcoma . . . . . . . . . .3
Page 211 and 212:
Target groups for preventive treatm
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