Childhood tuberculosis (TB) is affected by the HIV epidemic directly and indirectly. Direct effects in HIV-infected children include an increased mortality, a poorer response to treatment with children remaining culture positive longer and an increased likelihood of relapse and/or re-infection after treatment completion. Indirect effects include fragmented homes in which many of the adults are themselves TB infected and diseased and the unavailability of adult family members to supervise TB treatment. Amongst 49 children from Cape Town community with a high TB and HIV incidence, only 11 children (22%) were cared for by both the mother and father. 5 mothers (12%) and 10 fathers (20%) were known to have died. In a further 11 neither parent was involved in the children’s care

Because of the difficulty of confirming childhood TB, accurate figures for the incidence of HIV infection amongst children with TB are not readily available. At the Brooklyn Hospital for Chest Diseases, Cape Town the incidence of HIV infection amongst children with TB (culture-positive in approximately 50% of cases) has varied from 25-30% since 1998. In 2 separate studies the mortality amongst those HIV- infected was 17% (1998-1999) and 14% (2000-2001) compared to 2% (P<0.001) and 2% (P<0.017) respectively amongst those not HIV infected. Extra-pulmonary TB was not more common amongst HIV-infected children, but a higher proportion of HIV-infected children had intra-thoracic disease on chest radiography (P0.025). Mantoux skin testing (MST) was more often positive (>15mm induration) amongst HIV-uninfected children (72%) than amongst those HIV-infected (31%). 12% of HIV-infected children had a result between 5 and 14 mm induration. In a later study MST was repeated in children with a <5mm induration;  amongst HIV-infected children 13 of 41 (32%) had an induration of >15mm, but 17 (41%) on retesting. 

Atypical mycobacterioses appear to be relatively infrequent in TB high incidence communities even in the presence of high HIV infection rates. In a published study from our hospital of 183 mycobacterial isolates from 49 HIV-infected infants, M bovis BCG was identified from 5 children (10%) and in 2 cases was isolated from gastric aspirate, but no other mycobacteria, other than M tuberculosis. The inherent resistance of certain BCG strains to low concentrations of isoniazid and to pyrazinamide should be kept in mind when treating disseminated BCG.