TY - JOUR
T1 - Poor Obstetric and Infant Outcomes in Human Immunodeficiency Virus-Infected Pregnant Women with Tuberculosis in South Africa
T2 - The Tshepiso Study
AU - Salazar-Austin, Nicole
AU - Hoffmann, Jennifer
AU - Cohn, Silvia
AU - Mashabela, Fildah
AU - Waja, Ziyaad
AU - Lala, Sanjay
AU - Hoffmann, Christopher
AU - Dooley, Kelly E.
AU - Chaisson, Richard E.
AU - Martinson, Neil
N1 - Funding Information:
Financial support. This work was supported by the National Institutes of Child Health and Human Development (grant R01HD064354 to R. E. C.); the National Institute of Allergy and Infectious Diseases (grant K23AI080842 to K. E. D.); and the National Institutes of Health (grant P30A1094189 to R. E. C.).
Publisher Copyright:
© 2017 The Author(s).
PY - 2018/3/5
Y1 - 2018/3/5
N2 - Background. Before the wide availability of antiretroviral therapy (ART), tuberculosis and human immunodefciency virus (HIV) disease among pregnant women resulted in poor maternal and neonatal outcomes, including high rates of mother-to-child transmission of both HIV and tuberculosis. We aimed to describe the impact of tuberculosis among HIV-infected mothers on obstetric and infant outcomes in a population with access to ART. Methods. In this prospective cohort study, we followed up HIV-infected pregnant women with or without tuberculosis disease from January 2011 through January 2014 in Soweto, South Africa. Two controls were enrolled for each case patient, matched by enrollment time, maternal age, gestational age, and planned delivery clinic and followed up for 12 months afer delivery. Results. We recruited 80 case patients and 155 controls, resulting in 224 live-born infants. Infants of mothers with HIV infection and tuberculosis disease had a higher risk of low birth weight (20.8% vs 10.7%; P =.04), prolonged hospitalization at birth (51% vs 16%; P <.001), infant death (68 vs 7 deaths per 1000 births; P <.001), and tuberculosis disease (12% vs 0%; P <.001) despite appropriate maternal therapy and infant tuberculosis preventive therapy. HIV transmission was higher among these infants (4.1% vs 1.3%; P =.20), though this di?erence was not statistically signifcant. Obstetric outcomes in coinfected women were also poorer with higher risks of maternal hospitalization (25% vs 11%; P =.005) and preeclampsia (5.5% vs 0.7%; P =.03). Conclusions. Tuberculosis in HIV coinfected pregnant women remains a signifcant threat to the health of both mothers and infants. Improving tuberculosis prevention and early diagnosis among pregnant women is critical.
AB - Background. Before the wide availability of antiretroviral therapy (ART), tuberculosis and human immunodefciency virus (HIV) disease among pregnant women resulted in poor maternal and neonatal outcomes, including high rates of mother-to-child transmission of both HIV and tuberculosis. We aimed to describe the impact of tuberculosis among HIV-infected mothers on obstetric and infant outcomes in a population with access to ART. Methods. In this prospective cohort study, we followed up HIV-infected pregnant women with or without tuberculosis disease from January 2011 through January 2014 in Soweto, South Africa. Two controls were enrolled for each case patient, matched by enrollment time, maternal age, gestational age, and planned delivery clinic and followed up for 12 months afer delivery. Results. We recruited 80 case patients and 155 controls, resulting in 224 live-born infants. Infants of mothers with HIV infection and tuberculosis disease had a higher risk of low birth weight (20.8% vs 10.7%; P =.04), prolonged hospitalization at birth (51% vs 16%; P <.001), infant death (68 vs 7 deaths per 1000 births; P <.001), and tuberculosis disease (12% vs 0%; P <.001) despite appropriate maternal therapy and infant tuberculosis preventive therapy. HIV transmission was higher among these infants (4.1% vs 1.3%; P =.20), though this di?erence was not statistically signifcant. Obstetric outcomes in coinfected women were also poorer with higher risks of maternal hospitalization (25% vs 11%; P =.005) and preeclampsia (5.5% vs 0.7%; P =.03). Conclusions. Tuberculosis in HIV coinfected pregnant women remains a signifcant threat to the health of both mothers and infants. Improving tuberculosis prevention and early diagnosis among pregnant women is critical.
KW - HIV
KW - infant mortality
KW - pregnancy
KW - tuberculosis
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U2 - 10.1093/cid/cix851
DO - 10.1093/cid/cix851
M3 - Article
C2 - 29028970
AN - SCOPUS:85040934411
SN - 1058-4838
VL - 66
SP - 921
EP - 929
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -