16.1.3  Diagnosis of tuberculosis in HIV-positive children

As in adults, pulmonary TB (PTB) is the most common manifestation of TB in HIV-positive children. The diagnosis of PTB in children under four years old has always been difficult, and infection with HIV makes the effective diagnosis of TB in such cases more challenging.

The approach to diagnosing TB in HIV-infected children is essentially the same as for those children who are HIV-negative, i.e. the presence of three or more of the characteristic symptoms indicates a diagnosis of TB. It is especially important to look for chronic symptoms suggestive of TB, and for physical signs that are highly suggestive of TB — including the results of chest X-ray findings (refer to Study Session 14). Children who present with chronic symptoms suggestive of TB also need testing for HIV infection.