Postpartum Tuberculosis Incidence and Mortality among HIV-Infected Women and Their Infants in Pune, India, 2002-2005

Gupta, Amita; Nayak, Uma; Ram, Malathi; Bhosale, Ramesh; Patil, Sandesh; Basavraj, Anita; Kakrani, Arjun; Philip, Sheeja; Desai, D.B.; Sastry, Jayagowri; Bollinger, Robert C.

doi:10.1086/518974

Cited by 118 publications

(110 citation statements)

References 23 publications

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“…In India, the country with the highest burden of TB, 75% of cases in women are diagnosed in this age group (2). Postpartum TB incidence is also high (3)(4)(5)(6)(7). Because TB is a major cause of maternal mortality, especially among women infected with HIV (8,9), understanding how pregnancy affects diagnostics and the disease course would improve TB prevention efforts in this highrisk population.…”

Section: /Tstmentioning

confidence: 99%

Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women

Mathad

Bhosale

Balasubramanian

et al. 2016

Am J Respir Crit Care Med

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Rationale: Pregnant women with latent tuberculosis infection (LTBI) are at high risk for development of TB, especially if infected with HIV.Objectives: To assess the performance of LTBI tests in pregnant and postpartum women infected with HIV, investigate the immunology behind discordance in pregnancy, and explore the implications for the development of postpartum TB.Methods: We screened pregnant women in their second/third trimester and at delivery for LTBI using the tuberculin skin test (TST) and IFN-g release assay (IGRA) (QuantiFERON Gold). A subset of antepartum women had longitudinal testing, with repeat testing at delivery and postpartum and additional cytokines measured from the IGRA supernatant. The kappa statistic and Wilcoxon rank sum test were used to determine agreement and comparison of cytokine concentrations, respectively.Measurements and Main Results: Of 252 enrolled, 71 (28%) women had a positive IGRA but only 27 (10%) had a positive TST (P , 0.005). There was 75% agreement (kappa, 0.25). When stratified by pregnancy versus delivery, 20% had IGRA 1 /TST 2 discordance at each time point. A positive IGRA was associated with known TB contact (odds ratio, 3.6; confidence interval, 1.2-11.1; P = 0.02). Compared with IGRA 1 /TST 1 , women with IGRA 1 /TST 2 discordance had significantly less IFN-g (1.85 vs. 3.48 IU/ml; P = 0.02) and IL-2 (46.17 vs. 84.03 pg/ml; P = 0.01). Five developed postpartum TB, of which three had IGRA 1 /TST 2 discordance during pregnancy.Conclusions: Choice of LTBI test in pregnant women infected with HIV affects results. Pregnant women with IGRA 1 /TST 2 discordance had less IFN-g and IL-2 than those with concordant-positive results and may represent an especially high-risk subset for the development of active TB postpartum.

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Section: /Tstmentioning

confidence: 99%

Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women

Mathad

Bhosale

Balasubramanian

et al. 2016

Am J Respir Crit Care Med

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“…HIV and TB co-infection during pregnancy have a multiplier effect on maternal morbidity and mortality, and result in poorer pregnancy outcomes. 1,11 In Pune, India, TB increased the probability of death by 2.2-fold among HIV-infected women who developed TB and by 3.4-fold for their infants compared to women who did not develop TB. 11 In Johannesburg, South Africa, 70% of obstetric deaths in HIV-infected women were mainly attributed to TB.…”

mentioning

confidence: 99%

“…1,11 In Pune, India, TB increased the probability of death by 2.2-fold among HIV-infected women who developed TB and by 3.4-fold for their infants compared to women who did not develop TB. 11 In Johannesburg, South Africa, 70% of obstetric deaths in HIV-infected women were mainly attributed to TB. 12 These fi gures suggest that routine screening of pregnant women for TB in endemic settings would be helpful, particularly those who are HIV-infected.…”

mentioning

confidence: 99%

Screening for tuberculosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya

Kosgei¹,

Szkwarko²,

Callens³

et al. 2013

public health action

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underdiagnosis of active TB disease during the antenatal and postnatal periods. HIV and TB co-infection during pregnancy have a multiplier effect on maternal morbidity and mortality, and result in poorer pregnancy outcomes. 1,11 In Pune, India, TB increased the probability of death by 2.2-fold among HIV-infected women who developed TB and by 3.4-fold for their infants compared to women who did not develop TB. 11 In Johannesburg, South Africa, 70% of obstetric deaths in HIV-infected women were mainly attributed to TB. 12 These fi gures suggest that routine screening of pregnant women for TB in endemic settings would be helpful, particularly those who are HIV-infected.The World Health Organization (WHO) recommends ruling out active TB and identifying those in need of further testing among HIV-infected adults using specifi c symptoms (current cough of any duration, fever, weight loss or night sweats). 13 Although these recommendations were not specifi c for pregnancy, Gupta et al. used this recommendation and found a 1.4% (11/799) prevalence of active TB among HIVi nfected pregnant women who were part of a clinical trial in India. 14 Another study of cough of >2 weeks, performed in Kenya by the same clinical team and by the same fi rst author in a routine setting similar to the target population for this study, failed to identify those with TB disease (n = 187). 15 The current study differs from the earlier one in its larger sample size and because it compares HIV-infected and non-infected pregnant women.Data on the utilization of symptom screening among pregnant women in routine settings are scarce. This has been attributed to signifi cant fi nancial and logistical challenges in the implementation of screening in this group of patients. 1 The objectives of the present study were 1) to explore the utility of TB symptom screening using symptoms of ⩾2 weeks' duration in a routine setting, and 2) to compare differences in diagnosis of TB among HIV-infected and non-infected pregnant women in western Kenya. METHODS Study designThis was a descriptive cohort study among HIV-infected and non-infected pregnant women. R eduction of tuberculosis (TB) transmission, morbidity and mortality relies largely on intensifi ed case fi nding, with consequent early initiation of adequate treatment. 1,2 This is particularly important among pregnant women in resource-limited settings where TB is a cause of non-obstetrical (indirect) maternal deaths. 3,4 This burden is higher in settings with a high prevalence of human immunodefi ciency virus (HIV) infection. 5,6 Kenya has an adult HIV prevalence of 6.2%, 7 with an unacceptably high maternal mortality ratio of 488 per 100 000 live births; 25% of these deaths are attributed to indirect causes such as TB, anaemia, HIV and malaria. 8 TB case notifi cation data are not stratifi ed for pregnancy, but women of reproductive age bear a higher burden of TB in sub-Saharan Africa than their male counterparts. 1,9 Data from Western Cape, South Africa, indicate that there is a 24.2-fold higher incidenc...

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“…Other interventions exist whose potential can be tapped to prevent TB disease and death in both women and young children. [115][116][117][118][119] Contact investigation in TB patient households constitutes an effective screening strategy to find more TB cases; 65 it is also high yield in the households of individuals sick with DR-TB. 64 The highest yields should be expected among the youngest children, 84 who are the least likely to be recognized as TB cases without contact investigation.…”

Section: Utility Of a Targets Frameworkmentioning

confidence: 99%

Commentary: A targets framework: Dismantling the invisibility trap for children with drug-resistant tuberculosis

Becerra

Swaminathan

2014

J Public Health Pol

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Tuberculosis (TB) is an airborne infectious disease that is both preventable and curable, yet it kills more than a million people every year. Children are highly vulnerable, but often invisible casualties. Drug-resistant forms of TB are on the rise globally, and children are as vulnerable as adults but less likely to be counted as cases of drug-resistant disease if they become sick. Four factors make children with drug-resistant TB 'invisible': first, the nature of the disease in children; second, deficiencies in existing diagnostic tools; third, overreliance on these tools; and fourth, our collective failure to deploy one effective tool for finding and treating children -contact investigation. We describe a nascent science-advocacy network -the Sentinel Project on Pediatric Drug-Resistant Tuberculosis -whose goal is to end child deaths from this disease. Provisional annual targets, focused on children exposed at home to multidrug-resistant TB, to be updated every year, constitute a framework to focus attention and collective actions at the community, national, and global levels. The targets in two age groups, under 5 and 5-14 years old, tell us the number of: (i) children who require complete evaluation for TB disease and infection; (ii) children who require treatment for TB disease; and (iii) children who would benefit from preventive therapy.

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Postpartum Tuberculosis Incidence and Mortality among HIV-Infected Women and Their Infants in Pune, India, 2002-2005

Cited by 118 publications

References 23 publications

Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women

Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women

Screening for tuberculosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya

Commentary: A targets framework: Dismantling the invisibility trap for children with drug-resistant tuberculosis

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