Poor Obstetric and Infant Outcomes in Human Immunodeficiency Virus-Infected Pregnant Women With Tuberculosis in South Africa: The Tshepiso Study

Abstract

Tuberculosis in HIV coinfected pregnant women remains a significant threat to the health of both mothers and infants. Improving tuberculosis prevention and early diagnosis among pregnant women is critical.

Population Pharmacokinetics of Isoniazid, Pyrazinamide, and Ethambutol in Pregnant South African Women with Tuberculosis and HIV

“…The patients included in this analysis were enrolled in the Tshepiso Study, a prospective cohort study evaluating the effects of tuberculosis on maternal and infant outcomes in women with HIV infection. The clinical outcomes and pharmacokinetic analysis of rifampin and efavirenz have been published previously (10,28), as have the main study results (6). The participants included in the current analysis were enrolled in the Tshepiso Study's pharmacokinetic substudy (10).…”

“…significant risk of low birth weight, tuberculosis, and early mortality (6). Thus, optimizing the care of pregnant women with HIV-associated TB is critically important.…”

State‐of‐the‐Art Review of HIV‐TB Coinfection in Special Populations

“…Coinfection among women is deadly, and in 2016, there were globally 115,000 TB‐related deaths in women with HIV aged ≥15 years . Among HIV‐infected pregnant women, concurrent TB increases the risk of preeclampsia, low birth weight, hospitalization, and maternal‐to‐child transmission of HIV …”

“…1 Among HIV-infected pregnant women, concurrent TB increases the risk of preeclampsia, low birth weight, hospitalization, and maternal-to-child transmission of HIV. 19,20 Current WHO guidance calls for the initiation of ART for all HIV-positive people with TB within the first 8 weeks of starting TB treatment. Of the total 476,774 global notifications of HIVassociated TB in 2016, the number receiving ART was 399,146, or 85% of the total, representing a dramatic overall improvement in ART coverage from past years, although ART uptake is variable among the high-burden nations.…”

TB prevention strategies and unanswered questions for pregnant and postpartum women living with HIV: the need for improved evidence

“…

To end the tuberculosis (TB) epidemic, the World Health Organization (WHO) recommends improving access to testing and treatment of latent TB infection (LTBI) [1]. Despite recent epidemiologic studies demonstrating an approximately twofold increased risk of active TB in peripartum women [2], and poor outcomes associated with TB during pregnancy for mothers and their infants [3,4], lack of data has prevented comprehensive inclusion of pregnant and postpartum women in guidelines and remains a critical gap in our efforts to address TB globally.Because few TB studies include pregnant and lactating women, many questions remain, from TB epidemiology in pregnancy to optimal testing and treatment. In this viewpoint, we highlight knowledge gaps for TB prevention in pregnant and postpartum women living with HIV (PWLHIV) and opportunities to address them.Of 10 million new TB diagnoses each year, 3 million occur in women, the majority of whom are of childbearing age [5].

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