Tuberculosis in children who are HIV-exposed uninfected.

Jeffrey I Campbell; Ojasvi Vachharajani; Melanie M Dubois; Leonardo Martinez; Paul J Christos; Julie M Herlihy; Helen E Jenkins; C Robert Horsburgh; Karen R Jacobson; Kathleen M Powis

doi:10.1097/qad.0000000000004543

PubMed · 42138367

Tuberculosis in children who are HIV-exposed uninfected.

Jeffrey I Campbell·Ojasvi Vachharajani·Melanie M Dubois·Leonardo Martinez·Paul J Christos·Julie M Herlihy·Helen E Jenkins·C Robert Horsburgh·Karen R Jacobson·Kathleen M Powis

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Abstract

OBJECTIVES: 1.3 million children are born each year to mothers with HIV but remain HIV-uninfected; more than 70% of these children live in settings with high tuberculosis (TB) burden. Whether children who are HIV-exposed uninfected (cHEU) are at increased risk of TB infection and disease is debated. DESIGN: We performed a systematic review and meta-analysis of TB infection and disease in cHEU versus children who are HIV-unexposed uninfected (cHUU) and children with HIV (CWH). METHODS: We searched PubMed, Embase, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, and publication bibliographies through October 2025, using terms related to gestational HIV exposure and TB. We performed a qualitative synthesis and a meta-analysis of TST/IGRA positivity prevalence and disease cumulative incidence in cHEU versus cHUU, and cHEU versus CWH. RESULTS: : We included 26 studies in a systematic review and 18 studies in meta-analyses; 21/26 (81%) studies were restricted to children less than 2 years of age. Prevalence of TST/IGRA positivity [RR 1.26; 95% confidence interval (CI) 0.92-1.72, I2  = 0.0%] and cumulative disease incidence (RR 0.72; 95% CI 0.48-1.08, I2  = 0.0%) were similar between cHEU and cHUU. Prevalence of TST/IGRA positivity (RR 0.24; 95% CI 0.02-3.91, I2  = 93.2%) was not significantly different between cHEU and CWH. cHEU had lower risk of TB disease cumulative incidence than CWH (RR 0.29; 95% CI 0.16-0.51, I2  = 71.5%). CONCLUSION: cHEU and cHUU experience similar risk of TB infection and disease, while cHEU experience lower risk of disease than CWH. Findings were limited by a lack of studies after infancy and a small number of studies.

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Humans Tuberculosis HIV Infections Female Incidence Infant Child Child, Preschool Prevalence Pregnancy Male HIV-exposed child maternal HIV tuberculosis Journal Article Systematic Review Meta-Analysis

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Jeffrey I Campbell, Ojasvi Vachharajani, Melanie M Dubois, Leonardo Martinez, Paul J Christos, Julie M Herlihy, Helen E Jenkins, C Robert Horsburgh, Karen R Jacobson, Kathleen M Powis. 2026-05-15. Tuberculosis in children who are HIV-exposed uninfected.. https://doi.org/10.1097/qad.0000000000004543

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Child subject Child, Preschool subject Female subject HIV Infections subject Humans subject Incidence subject Infant subject Journal Article subject Journal Article; Systematic Review; Meta-Analysis resource Male subject Meta-Analysis subject Systematic reviews study

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