Maternal tuberculosis: a risk factor for mother-to-child transmission of human immunodeficiency virus

Citation: Gupta A, Bhosale R, Kinikar A, Gupte N, Bharadwaj R, Kagal A, Joshi S, Khandekar M, Karmarkar A, Kulkarni V, Sastry J, Mave V, Suryavanshi N, Thakar M, Kulkarni S, Tripathy S, Sambarey P, Patil S, Paranjape R, Bollinger RC, Jamkar A; Six Week Extended-Dose Nevirapine (SWEN) India Study Team. Maternal tuberculosis: a risk factor for mother-to-child transmission of human immunodeficiency virus. J Infect Dis. 2011 Feb 1;203(3):358-63. doi: 10.1093/infdis/jiq064. PMID: 21208928. PMCID: PMC3071111.

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http://www.ncbi.nlm.nih.gov/pubmed/21208928

BACKGROUND:

Maternal human immunodeficiency virus (HIV) RNA load, CD4 cell count, breast-feeding, antiretroviral use, and malaria are well-established factors associated with mother-to-child transmission (MTCT) of HIV; the role of maternal tuberculosis (TB), however, has not been well established.

METHODS:

The study population was 783 HIV-infected Indian mother-infant pair participants in randomized and ancillary HIV-infected cohorts of the Six Week Extended-Dose Nevirapine (SWEN) Study, a study comparing extended nevirapine versus single-dose nevirapine, to reduce MTCT of HIV among breast-fed infants. Using multivariable logistic regression, we assessed the impact of maternal TB occurring during pregnancy and through 12 months after delivery on risk of MTCT.

RESULTS:

Of 783 mothers, 3 had prevalent TB and 30 had incident TB at 12 months after delivery. Of 33 mothers with TB, 10 (30%) transmitted HIV to their infants in comparison with 87 of 750 mothers without TB (12%; odds ratio [OR], 3.31; 95% confidence interval [CI], 1.53-7.29; P = .02). In multivariable analysis, maternal TB was associated with 2.51-fold (95% CI, 1.05-6.02; P = .04) increased odds of HIV transmission adjusting for maternal factors (viral load, CD4 cell count, and antiretroviral therapy) and infant factors (breast-feeding duration, infant nevirapine administration, gestational age, and birth weight) associated with MTCT of HIV.

CONCLUSIONS:

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.

J Infect Dis. 2011 Feb 1;203(3):358-63. doi: 10.1093/infdis/jiq064. PubMed PMID: 21208928; PubMed Central PMCID: PMC3071111

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