Preventive Therapy Should be Considered to Avert Postpartum TB Among HIV-Infecte

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Preventive Therapy Should be Considered to Avert Postpartum TB Among

HIV-Infected Women in India

Active screening and targeted use of isoniazid preventative therapy

(IPT) among HIV-infected women in India should be considered to avert

postpartum TB, according to a recent study supported by a Fogarty

AIDS International Training and Research Project grant.

More than 700 HIV-infected mothers and their infants were followed

for one year after delivery at a public hospital in Pune, India. The

women were evaluated for active TB during regular clinic visits and

tuberculin skin tests were performed by a research team led by s

Hopkins University School of Medicine's Dr. Amita Gupta. World Health

Organization (WHO) definitions for confirmed, probable and presumed

TB were used. The researchers used poisson regression to determine

correlation of incident TB, and calculate the adjusted probabilities

of mortality.

In the absence of preventive TB vaccines, the United Nations AIDS

Program and WHO, as well as the Centers for Disease Control and

Prevention guidelines, currently recommend IPT for HIV infected

adults with latent TB. Targeted IPT has been shown to reduce the risk

of active TB by up to 60 percent both in regions where TB is endemic

and in regions where it is not endemic.

Despite India's large HIV and TB burden, the country's guidelines do

not currently recommend IPT. There is legitimate concern that

widespread and inappropriate use of the therapy could increase the

community burden of isoniazid-resistant TB infection and limit the

success of the national TB-control program, the study says. Indian

HIV-infected women have a high risk of TB during the postpartum

period, regardless of their CD4 cell count, which is associated with

the need for infant TB prophylaxis and high rates of postpartum

maternal and infant death.

The research team concluded that although widespread use of IPT in

India may be problematic, targeted administration of IPT to

antepartum HIV-infected women is likely to have great benefit for

preventing postpartum maternal TB, and reduce the associated high

incidence of morbidity and mortality caused by mother-to-child

transmission of infection. The study was supported by Fogarty and the

National Institute of Allergy and Infectious Diseases. It was

undertaken in collaboration with the Byramjee Jeejeebhoy Medical

College and the s Hopkins University Study Group.

Postpartum tuberculosis incidence and mortality among HIV-infected

women and their infants in Pune, India 2002-2005. Gupda A, Nayak U,

Ram M, Bhosale R, Patil S, Basawraj A, Kakrani A, Philip S, Desai D,

Sastry J, Bollinger RC. Clinical Infectious Diseases, volume 45, June

2007.

To access full text, visit:

www.journals.uchicago.edu/cgi-bin/resolve?id=doi:10.1086/518974