Maternal Tuberculosis: A Risk Factor for Mother-to-Child Transmission of Human Immunodeficiency Virus

Gupta, Amita; Bhosale, Ramesh; Kinikar, Arti; Gupte, Nikhil; Bharadwaj, Renu; Kagal, Anju; Joshi, Suvarna; Khandekar, Medha; Karmarkar, Alaka; Kulkarni, Vandana; Sastry, Jayagowri; Mave, Vidya; Suryavanshi, Nishi; Thakar, Madhuri; Kulkarni, Smita; Tripathy, Srikanth; Sambarey, Pradeep; Patil, Sandesh; Paranjape, Ramesh; Bollinger, Robert C.; Jamkar, Arun

doi:10.1093/infdis/jiq064

Cited by 55 publications

(56 citation statements)

References 15 publications

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“…1 Latent TB infection (LTBI) during pregnancy in HIV-1 infected women is associated with increased risk of postpartum tuberculosis, maternal and infant mortality and infant HIV-1 transmission. 2–4 Although the World Health Organization (WHO) recommends isoniazid prophylaxis therapy (IPT) to all HIV-1 infected individuals, including pregnant women, global coverage of this intervention is <1%. 5 Alternative targeted strategies may be useful.…”

Section: Introductionmentioning

confidence: 99%

Predictive value of interferon-gamma release assays for postpartum active tuberculosis in HIV-1-infected women

Jonnalagadda

Brown

Lohman-Payne

et al. 2013

int j tuberc lung dis

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Background There are limited data on prognostic utility of interferon-gamma (IFN-γ) release assays (IGRAs) for active tuberculosis (TB) among HIV-1 infected individuals. Methods Samples from a perinatal cohort of HIV-1 infected women in Kenya, obtained during pregnancy were tested using T-SPOT.TB IGRAs to detect Mycobacterium tuberculosis (MTB)-specific IFN-γ responses. IFN-γ (cut-off values>0, ≥6 and ≥10 spot forming cells/well (SFCs/well)) and CD4 cell count (cut-off values<250 and <350 cells/μL) were evaluated for sensitivity and specificity using a time dependent receiver operating characteristic (ROC) curve and positive predictive value (PPV) using Kaplan Meier method for future TB within one year postpartum. Results Of 327 women, 9 developed TB within one year postpartum (Incidence rate (IR): 3.5/100 person-years of follow-up (pyfu); 95% confidence interval: 1.6–6.7/100 pyfu). IFN-γ≥6 SFCs/well was associated with an optimal trade-off between sensitivity (78%) and specificity (55%) and PPV of 5.9%. In women with CD4<250 cells/μL, sensitivity and specificity of IFN-γ≥6 SFCs/well were 89% and 63%, respectively and PPV was 19.2%. Conclusion Among HIV-1 infected women, IFN-γ response (≥6 SFCs/well) during pregnancy lacked high positive predictive value for postpartum TB but had higher sensitivity and positive predictive value among immunosuppressed women (CD4<250 cells/μL).

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Section: Introductionmentioning

confidence: 99%

Predictive value of interferon-gamma release assays for postpartum active tuberculosis in HIV-1-infected women

Jonnalagadda

Brown

Lohman-Payne

et al. 2013

int j tuberc lung dis

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“…Maternal TB disease has previously been shown to be an independent risk factor for infant HIV infection, which may be mediated by immune activation and increased HIV replication. 28 A positive maternal WHO TB screen in our cohort may be a proxy for maternal TB disease or be associated with other mother-to-child HIV transmission risk factors that we were not able to adjust for, such as maternal viral load. However, the association between maternal TB symptoms and infant HIV infection remained significant in multivariable analyses adjusted for use of maternal cART and infant antiretroviral prophylaxis.…”

Section: Discussionmentioning

confidence: 90%

Integrating tuberculosis screening in Kenyan Prevention of Mother-To-Child Transmission programs

Cranmer

Langat

Ronen

et al. 2017

int j tuberc lung dis

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SUMMARY Background Tuberculosis (TB) screening in prevention of mother-to-child transmission (PMTCT) programs is important to improve TB detection, prevention and treatment. Methods As part of a national PMTCT program evaluation, mother-infant pairs attending 6-week and 9-month immunization visits were enrolled at 141 maternal and child health clinics throughout Kenya. Clinics were selected using population-proportion-to-size sampling with oversampling in a high HIV prevalence region. The World Health Organization (WHO) TB symptom screen was administered to HIV-infected mothers and associations with infant cofactors were determined. Results Among 498 HIV-infected mothers, 165 (33%) had a positive TB symptom screen. Positive maternal TB symptom screen was associated with prior TB (p=0.04). Women with a positive TB symptom screen were more likely to have an infant with HIV infection (p=0.02) and non-specific TB symptoms, including cough (p=0.003), fever (p=0.05), and difficulty breathing (p=0.01). TB exposure was reported by 11% of women, and 15% of TB-exposed women received isoniazid preventive therapy. Conclusions Postpartum HIV-infected mothers frequently had a positive TB symptom screen. Mothers with a positive TB symptom screen were more likely to have infants with HIV or non-specific TB symptoms. Integration of maternal TB screening and prevention into PMTCT programs may improve maternal and infant outcomes.

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“…In our case, the mother did not receive any antenatal care and only visited the hospital at the time of delivery, which greatly reduced opportunities for the prevention of mother-to-child transmission of HIV (PMTCT) [5]. The fact that pregnant women are at increased risk of developing TB [6], while active TB also increases the risk of HIV disease progression and vertical transmission [7], provides strong motivation to routinely screen all pregnant women in TB endemic areas for HIV infection, as well as TB disease.…”

Section: Discussionmentioning

confidence: 99%

TB Presenting as Recurrent Pneumonia in a HIV-Infected Infant in Central Viet Nam

Nguyen

et al. 2018

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Abstract:We report on a six-month-old infant admitted to our intensive care unit (ICU) with recurrent severe pneumonia. The mother was infected with human immunodeficiency virus (HIV)-infected, but initially failed to disclose this to doctors. Neither did she report the grandmother of the child's chronic coughing, likely due to tuberculosis (TB). The infant was diagnosed with X-pert MTB/RIF ® confirmed TB and tested positive for HIV infection. Once a correct diagnosis was established, the child demonstrated good recovery with appropriate TB and antiretroviral treatment (ART). The case demonstrates the importance of including TB in the differential diagnosis for young children not responding to first-line pneumonia treatment, especially in TB endemic areas. Taking a meticulous TB and HIV exposure history, with careful consideration of potential social stigma, is essential. It also demonstrates how the inaccessibility of HIV results and the absence of a continuous patient record may jeopardize patient care.Keywords: tuberculosis; Mycobacterium tuberculosis; infant; HIV; opportunistic infection Case ReportWe admitted a six-month-old girl to the Da Nang Hospital for Women and Children, a provincial referral hospital in central Viet Nam, with a diagnosis of recurrent severe pneumonia. She was discharged from the same hospital two days earlier, but developed a fever with associated heavy breathing at home. On admission, she weighed 5.5 kg and her vital signs were temperature 39 • C, breathing rate 80/min, heart rate 135 beats/min and peripheral oxygen saturation (SpO 2 ) 88% in air; 95% with high flow nasal oxygen.On examination, she was alert, but malnourished with visible chest indrawing. On physical examination she had extensive white plaques in her mouth, suggestive of oral thrush, and hepatosplenomegaly. On auscultation she had symmetric air entry with normal vesicular breathing and no abnormal breath sounds. She was admitted to the intensive care unit (ICU) for intravenous (IV) antibiotics (ceftazidime and gentamycin) and oxygen supplementation. Initial laboratory investigations revealed an abnormal full blood count (hemoglobin: 8.7 g/dL; white blood cells: 10.5 ×

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Maternal Tuberculosis: A Risk Factor for Mother-to-Child Transmission of Human Immunodeficiency Virus

Abstract: Maternal TB is associated with increased MTCT of HIV. Prevention of TB among HIV-infected mothers should be a high priority for communities with significant HIV/TB burden.

Cited by 55 publications

References 15 publications

Predictive value of interferon-gamma release assays for postpartum active tuberculosis in HIV-1-infected women

Predictive value of interferon-gamma release assays for postpartum active tuberculosis in HIV-1-infected women

Integrating tuberculosis screening in Kenyan Prevention of Mother-To-Child Transmission programs

TB Presenting as Recurrent Pneumonia in a HIV-Infected Infant in Central Viet Nam

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