Antonio first showed signs of being sick with TB in 1997, at the age of six. He was diagnosed with TB that same year. Three years later Antonio was diagnosed with MDR-TB through a positive culture obtained by gastric aspiration, an uncomfortable procedure where a tube is inserted through the nose or mouth to obtain a sample from the stomach. Though Antonio’s mother and father were both HIV-positive, neither had DR-TB, and no other close contact with DR-TB was identified. Antonio was treated for MDR-TB for 12 months, after which a gastric aspirate was again performed with a negative result.
Antonio’s co-infection with HIV as well as his acute malnutrition (below the 5th percentile of the Brazilian National Center for Health Statistics) put him at increased risk of becoming sick with TB. Because of co-infection with HIV and MDR-TB, not only did Antonio have to deal with a high pill burden throughout treatment, which is especially challenging for a child, but he was also subjected to two gastric aspirations, which are invasive and unpleasant procedures. Antonio’s experience shows why we urgently need improved diagnostic tools and child-friendly drug formulations that also allow for treatment with a reduced pill burden.