Interferon Gamma Release Assay and Tuberculin Skin Test Performance in Pregnant Women Living With and Without HIV

Kaplan, Samantha R.; Escudero, Jaclyn N; Mecha, Jerphason; Richardson, Barbra A.; Maleche‐Obimbo, Elizabeth; Matemo, Daniel; Kinuthia, John; John‐Stewart, Grace; LaCourse, Sylvia M

doi:10.1097/qai.0000000000002827

Cited by 13 publications

(20 citation statements)

References 34 publications

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“…We found that the QFT-Plus test positivity in this population of PLHIV was 39.7%, a rate corresponding to estimates from the general population in an equivalent context 33. This differs slightly from a similar study conducted among pregnant women in Kenya, where 35.8% of the pregnant women living with HIV had TB infection by QFT-Plus test positivity rate equivalent to those without HIV 32. In Nigeria, in a similar high HIV/TB burden setup, Aladesanmi et al found that 53% of PLHIV had TB infection 34.…”

Section: Discussioncontrasting

confidence: 83%

Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

et al. 2023

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BackgroundTuberculosis (TB) disease is the leading cause of mortality among people living with HIV (PLHIV). Interferon-gamma release assays (IGRAs) are approved for TB infection ascertainment. However, current IGRA data on the prevalence of TB infection in the context of near-universal access to antiretroviral therapy (ART) and TB preventive therapy (TPT) are lacking. We estimated the prevalence and determinants of TB infection among PLHIV within a high TB and HIV burden context.MethodsThis cross-sectional study included data from adult PLHIV age ≥18 years in whom QuantiFERON-TB Gold Plus (QFT-Plus) assay, an IGRA, was performed. TB infection was defined as a positive or indeterminate QFT-Plus test. Participants with TB and those who had previously used TPT were excluded. Regression analysis was performed to identify independent predictors of TB infection.ResultsOf 121 PLHIV with QFT-Plus test results, females were 74.4% (90/121), and the mean age was 38.4 (SD 10.8) years. Overall, 47.9% (58/121) were classified as TB infection (QFT-Plus test positive and indeterminate results were 39.7% (48/121) and 8.3% (10/121), respectively). Being obese/overweight (body mass index ≥25 kg/m2; p=0.013, adjusted OR (aOR) 2.90, 95% CI 1.25 to 6.74) and ART usage for >3 years (p=0.013, aOR 3.99, 95% CI 1.55 to 10.28) were independently associated with TB infection.ConclusionThere was a high TB infection prevalence among PLHIV. A longer period of ART and obesity were independently associated with TB infection. The relationship between obesity/overweight and TB infection may be related to ART use and immune reconstitution and requires further investigation. Given the known benefit of test-directed TPT among PLHIV never exposed to TPT, its clinical and cost implications for low and middle-income countries should be explored further.

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Section: Discussioncontrasting

confidence: 83%

Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

et al. 2023

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“…Children in HIV/TB endemic areas are at high risk of Mtb infection, which can quickly progress to TB disease due to their developing immunity. 4,8,14,15 A systematic review and meta-analysis estimated a 20% TB risk for young children within 2 years of exposure, with the majority of children under 5 years developing TB disease within a few months of exposure. 2 Our findings are consistent with those of a randomized clinical trial conducted in western Kenya, assessing the efficacy of isoniazid in HIV-exposed infants to prevent primary Mtb infection, in which the majority of TST conversions occurring in the first year of life (8.6/100 PY), though cumulative Mtb infection incidence was lower in this cohort study (3.6/100 PY), which enrolled both HIV-exposed and unexposed infants.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Description of parent cohort design, and baseline maternal characteristics and results of baseline maternal QFT-Plus and TST testing in pregnancy have been previously reported. 14…”

Section: Methodsmentioning

confidence: 99%

“…12,13 Description of parent cohort design, and baseline maternal characteristics and results of baseline maternal QFT-Plus and TST testing in pregnancy have been previously reported. 14 At the time of study implementation, Kenyan national guidelines recommended a 6-month course of IPT for persons with HIV including pregnant women. 15 Women with HIV and infants found to have positive TST (and/or QFT-Plus for mothers) as well as participants with reported TB exposure during the study were referred for IPT evaluation if they had not already received IPT.…”

Section: Study Proceduresmentioning

confidence: 99%

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Maternal HIV Status and Risk of Infant Mycobacterium tuberculosis Infection as Measured by Tuberculin Skin Test

Mecha,

Escudero,

Richardson

et al. 2023

Pediatric Infectious Disease Journal

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Background: The effect of maternal HIV on infant Mycobacterium tuberculosis (Mtb) infection risk is not well-characterized. Methods: Pregnant women with/without HIV and their infants were enrolled in a longitudinal cohort in Kenya. Mothers had interferon gamma-release assays (QFT-Plus) and tuberculin skin tests (TST) at enrollment in pregnancy; children underwent TST at 12 and 24 months of age. We estimated the incidence and correlates of infant TST-positivity using Cox proportional hazards regression. Results: Among 322 infants, 170 (53%) were HIV-exposed and 152 (47%) were HIV-unexposed. Median enrollment age was 6.6 weeks [interquartile range (IQR): 6.1–10.0]; most received Bacillus Calmette-Guerin (320, 99%). Thirty-nine (12%) mothers were TST-positive; 102 (32%) were QFT-Plus-positive. Among HIV-exposed infants, 154 (95%) received antiretrovirals for HIV prevention and 141 (83%) of their mothers ever received isoniazid preventive therapy (IPT). Cumulative 24-month infant Mtb infection incidence was 3.6/100 person-years (PY) [95% confidence interval (CI): 2.4–5.5/100 PY]; 5.4/100 PY in HIV-exposed infants (10%, 17/170) versus 1.7/100 PY in HIV-unexposed infants (3.3%, 5/152) [hazard ratio (HR): 3.1 (95% CI: 1.2–8.5)]. More TST conversions occurred in the first versus second year of life [5.8 vs. 2.0/100 PY; HR: 2.9 (95% CI: 1.0–10.1)]. Infant TST-positivity was associated with maternal TST-positivity [HR: 2.9 (95% CI: 1.1–7.4)], but not QFT-Plus-positivity. Among HIV-exposed children, Mtb infection incidence was similar regardless of maternal IPT. Conclusions: Mtb infection incidence (by TST) by 24 months of age was ~3-fold higher among HIV-exposed children, despite high maternal IPT uptake. Overall, more TST conversions occurred in the first 12 months compared to 12–24 months of age, similar in both HIV-exposed and HIV-unexposed children.

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“…Most existing studies use data from before the adoption of Option Bþ, which involves lifelong combination ART, often starting prepregnancy. We used a recent longitudinal study [24,25] to compare the growth and development of HEU and HUU children and to identify predictors of growth and development in the setting of universal material ART.…”

Section: Introductionmentioning

confidence: 99%

Maternal breastfeeding and education impact infant growth and development more than in-utero HIV/antiretroviral therapy exposure in context of universal antiretroviral therapy

Cherkos,

LaCourse,

Kinuthia

et al. 2023

Aids

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Background: Exposure to HIV and antiretroviral therapy (ART) in utero may influence infant growth and development. Most available evidence predates adoption of universal ART (Option B+ ART regimens). In a recent cohort, we compared growth and development in HIV-exposed uninfected (HEU) to HIV-unexposed (HUU) infants. Design: Prospective cohort study: data from Impact of Maternal HIV on Mycobacterium Tuberculosis Infection among Peripartum Women and their Infants (MiTIPS) in Western Kenya. Methods: Women were enrolled during pregnancy. Mother-infant pairs were followed until 24 months postpartum. We used multivariable linear mixed-effects models to compare growth rates (weight-for-age z-score [WAZ] and height-for-age z-score [HAZ]) and multivariable linear regression to compare overall development between HEU and HUU children. Results: About 51.8% (184/355) of the infants were HEU, 3.9% low birthweight (<2.5 kg), and 8.5% preterm (<37 gestational weeks). During pregnancy, all mothers of HEU received ART; 67.9% started ART pre-pregnancy, and 87.3% received 3TC/FTC,TDF,EFV. In longitudinal analyses, HEU children did not differ significantly from HUU in growth or development (p > 0.05 for all). In the combined HEU/HUU cohort, higher maternal education was associated with significantly better growth and development: WAZ (β=0.18 [95% CI:0.01, 0.34]), HAZ (β=0.26 [95% CI:0.04, 0.48], and development (β=0.24 [95% CI:0.02, 0.46]). Breastfeeding was associated with significantly better HAZ (β=0.42 [95% CI:0.19, 0.66]) and development (β=0.31 [95% CI:0.08, 0.53]). Conclusion: HEU children in the setting of universal maternal ART had a similar growth trajectory and development to HUU children. Breastfeeding and maternal education improved children's weight, height, and overall development irrespective of maternal HIV status.

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Interferon Gamma Release Assay and Tuberculin Skin Test Performance in Pregnant Women Living With and Without HIV

Cited by 13 publications

References 34 publications

Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

Maternal HIV Status and Risk of Infant Mycobacterium tuberculosis Infection as Measured by Tuberculin Skin Test

Maternal breastfeeding and education impact infant growth and development more than in-utero HIV/antiretroviral therapy exposure in context of universal antiretroviral therapy

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