The HIV/AIDS epidemic has led to a resurgence in the rates of tuberculosis in the developed world. In the developing world, co-infection with HIV and tuberculosis is extremely common and a major cause of morbidity and mortality. Tuberculosis in HIV-infected children can be more severe than disease in HIV-uninfected children, and treatment is complicated by drug—drug interactions between antiretrovirals and tuberculosis medications. Nevertheless, effective treatment of tuberculosis in the HIV-infected child is critically important for prolonged survival, even in the absence of antiretroviral therapy.

Epidemiology

Mycobacterium tuberculosis, the etiologic agent of tuberculosis, is the major species of the M. tuberculosis complex, which also includes M. bovis, M. ulcerans, M. microti, a rodent pathogen, and M. africanum, a rare cause of tuberculosis in Africa. Humans are the only reservoir for M. tuberculosis. In the USA the number of cases of tuberculosis in 2001 reached an all-time low of 15 991 cases [1]. The incidence rate had risen from the mid-1980s until 1992, secondary to the HIV epidemic and decreased attention to public health. Since 1992 there has been a steady decline in the number of cases per year. Pediatric surveillance data, which began in 1953, demonstrates a similar pattern of decline in the incidence until 1988, increase until 1992, and subsequent decline [2].

Internationally, the global burden of disease is staggering.