Latent Tuberculosis Detection by Interferon g Release Assay during Pregnancy Predicts Active Tuberculosis and Mortality in Human Immunodeficiency Virus Type 1–Infected Women and Their Children

Citation:
Jonnalagadda S, Barbara Lohman Payne, Elizabeth Brown, Dalton Wamalwa, Elizabeth Maleche Obimbo, Maxwel Majiwa, Carey. "Latent Tuberculosis Detection by Interferon g Release Assay during Pregnancy Predicts Active Tuberculosis and Mortality in Human Immunodeficiency Virus Type 1–Infected Women and Their Children." Journal of infectious diseases. 2010.

Abstract:

Background. We evaluated the prognostic usefulness of interferon g release assays (IGRAs) for active tuberculosis
and mortality in Kenyan human immunodeficiency virus type 1 (HIV-1)–infected women and their infants.
Methods. Prevalence and correlates of Mycobacterium tuberculosis–specific T-SPOT.TB IGRA positivity were
determined during pregnancy in a historical cohort of HIV-1–infected women. Hazard ratios, adjusted for baseline
maternal CD4 cell count (aHRCD4), were calculated for associations between IGRA positivity and risk of active
tuberculosis and mortality over 2-year postpartum follow-up among women and their infants.
Results. Of 333 women tested, 52 (15.6%) had indeterminate IGRA results. Of the remaining 281 women,
120 (42.7%) had positive IGRA results, which were associated with a 4.5-fold increased risk of active tuberculosis
(aHRCD4, 4.5; 95% confidence interval [CI], 1.1–18.0; Pp.030). For immunosuppressed women (CD4 cell count,
!250 cells/mL), positive IGRA results were associated with increased risk of maternal mortality (aHRCD4, 3.5; 95%
CI, 1.02–12.1; ), maternal active tuberculosis or mortality (aHRCD4Pp.045 , 5.2; 95% CI, 1.7–15.6; Pp.004), and
infant active tuberculosis or mortality overall (aHRCD4, 3.0; 95% CI, 1.0–8.9; Pp.05) and among HIV-1–exposed
uninfected infants (aHRCD4, 7.3; 95% CI, 1.6–33.5; Pp.01).
Conclusions. Positive IGRA results for HIV-1–infected pregnant women were associated with postpartum
active tuberculosis and mortality among mothers and their infants.

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