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Gestational HIV exposure does not increase tuberculosis disease risk in children who are HIV-exposed uninfectedComparing Tuberculosis Risk in Children Exposed to HIV During Pregnancy

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Key Takeaway
Note that gestational HIV exposure does not increase the risk of tuberculosis disease in children who are HIV-exposed uninfected.

This meta-analysis synthesized data from 18 studies to evaluate the impact of gestational HIV exposure on tuberculosis (TB) risk in children who are HIV-exposed uninfected (cHEU). The analysis compared cHEU children to both HIV-unexposed uninfected (cHUU) children and children with HIV (CWH).

Regarding infection markers, the meta-analysis found that TST/IGRA positivity prevalence was similar between cHEU and cHUU (RR 1.26; 95% CI 0.92-1.72). When comparing cHEU to CWH, TST/IGRA positivity was not significantly different (RR 0.24; 95% CI 0.02-3.91). In terms of clinical outcomes, the cumulative disease incidence was similar between cHEU and cHUU (RR 0.72; 95% CI 0.48-1.08). However, cHEU children showed a lower risk of cumulative disease compared to CWH (RR 0.29; 95% CI 0.16-0.51).

The authors noted limitations including a small number of studies and a lack of studies conducted after infancy. These findings suggest that while gestational exposure does not appear to increase TB risk compared to unexposed peers, the evidence base is limited by the age range of the included studies. Clinical interpretation should be cautious due to these limitations.

How this fits prior evidence

This meta-analysis addresses a gap in understanding how gestational HIV exposure affects tuberculosis risk in children. It confirms that cHEU children experience similar risk of TB infection and disease compared to cHUU children. While it does not directly relate to the previously covered topics of community health worker support, short-course regimens, IP-10 sensitivity, pulmonary rehabilitation, or biopsychosocial determinants, it provides specific data on the impact of maternal HIV status on pediatric TB outcomes.

Doctors looked at many studies to see how tuberculosis affects children who were exposed to HIV before birth but do not have the virus themselves. They compared these children to two other groups: children who were never exposed to HIV and children who currently have HIV.

The results showed that children exposed to HIV before birth have a similar chance of testing positive for tuberculosis as children who were never exposed. This means that being exposed to the virus during pregnancy does not seem to make it easier for these children to catch the tuberculosis bacteria.

When looking at actual sickness, the risk of developing full tuberculosis disease was also similar between the two groups of children who do not have HIV. However, children who currently have HIV are much more likely to get sick with the disease than those who were only exposed to the virus before birth.

These findings help doctors understand how to monitor health for different groups of children. While the risk of infection is similar for those exposed before birth, the risk of getting very sick is much lower compared to children living with HIV.

What this means for you:
Children exposed to HIV before birth have similar tuberculosis risks as those never exposed to the virus.

Common questions

Do children exposed to HIV during pregnancy have a higher risk of tuberculosis?

No, the study found that children who were exposed to HIV during pregnancy but are not infected have a similar risk of tuberculosis infection and disease compared to children who were never exposed to HIV.

How does the risk compare to children who actually have HIV?

Children exposed to HIV during pregnancy but not infected showed a lower risk of developing tuberculosis disease compared to children who actually have HIV.

Is this finding certain for all ages of children?

The findings are currently limited because there was a lack of studies specifically looking at children after the infancy stage.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original 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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