In Women with HIV, TB Preventive Therapy Poses Greater Risk in Pregnancy than Postpartum
National Institute of Allergy and Infectious Diseases
Study results published today help clarify how to safely prevent tuberculosis (TB) in women living with HIV who are pregnant or have recently given birth, are taking antiretroviral therapy, and live where TB is highly prevalent.
A clinical trial funded by the National Institutes of Health has found that for these women, treatment with the antibiotic isoniazid to prevent TB was similarly safe if begun during pregnancy or 12 weeks after delivery. However, there was significantly greater risk of poor health outcomes and death for the fetuses and newborns of these women if isoniazid preventive therapy began during pregnancy than if it began 12 weeks after delivery. This finding is concerning and merits research into alternative approaches to TB preventive therapy in pregnant women, according to the study investigators. Their findings are reported in the Oct. 3 issue of The New England Journal of Medicine.
“Pregnant women are often excluded from clinical research, which leads to an information gap that can pose a danger to maternal and infant health,” said Anthony S. Fauci, M.D. “The findings reported today give women, health-care providers and policy makers high-quality data for weighing the risks and benefits of TB preventive therapy for pregnant women living with HIV who are taking antiretroviral therapy.” Dr. Fauci is Director of the National Institute of Allergy and Infectious Diseases, a component of NIH that co-funded the trial.
TB is the top infectious-disease killer worldwide and the leading cause of death for people living with HIV. Among women, TB mainly affects those of reproductive age. When active TB disease develops during pregnancy or in the weeks after birth, it is associated with poor health outcomes for both the mother and baby.
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