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Children with HIV who are < 10 years should be screened for TB at every encounter with a health-care worker, with the following screen: cough, fever, poor weight gain or close contact with someone who has TB. The systematic review conducted for the 2021 screening guidelines showed that presence of any one of these conditions has a sensitivity of 61% and a specificity of 94%, and children who are positive on this screen should undergo further diagnostic evaluation for TB disease.
Screening for TB can be difficult in a child living with HIV. Even older children, who may otherwise be expected to have more typical “adult-type” TB disease if they are HIV-infected, frequently have extrapulmonary disease and atypical symptoms (43). Health-care workers should maintain strong clinical suspicion of TB in any child with HIV, even in the absence of classical symptoms of TB, especially in areas with a high TB burden.