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Int J Tuberc Lung Dis. 2015 Jul;19(7):792-8. doi: 10.5588/ijtld.14.0878.

Incidence and correlates of tuberculosis IGRA conversion among HIV-infected postpartum women.

Author information

1
Department of Epidemiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
2
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
3
Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
4
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya; Institute for Immunology and Informatics and Department of Cell and Molecular Biology, University of Rhode Island, Providence, Rhode Island, USA.
5
Child Health, University of Nairobi, Nairobi, Kenya.
6
Emory School of Medicine and Children's Healthcare of Atlanta, Division of Pediatric Infectious Disease, Atlanta, Georgia, USA.
7
Department of Epidemiology, Department of Medicine, University of Washington, Seattle, Washington, USA; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Global Health, University of Washington, Seattle, USA; Department of Global Health, University of Washington, Seattle, USA.

Abstract

SETTING:

Prevention of maternal-to-child transmission program at a tertiary care hospital in Nairobi, Kenya. The risk of acquiring Mycobacterium tuberculosis infection among peripartum human immunodeficiency virus (HIV) infected women is poorly defined.

OBJECTIVE:

To determine the incidence of and co-factors for interferon-gamma release assay (IGRA) conversion among postpartum HIV-infected women using T-SPOT.TB.

DESIGN:

We used data and cryopreserved peripheral blood mononuclear cells from a historical cohort of HIV-infected women enrolled at 32 weeks' gestation and followed for 1 year postpartum between 1999 and 2005.

RESULTS:

Of 89 women initially IGRA-negative during pregnancy, 11 (12.4%) became positive, 53 (59.5%) remained negative and 25 (28.1%) were indeterminate at 1 year postpartum. Mean interferon-gamma (IFN-γ) response among converters increased from ~1 to >50 spot-forming cells/well (P = 0.015). IGRA conversion was significantly associated with partner HIV infection, flush toilets, maternal illness and cough during follow-up, but not maternal CD4 count or HIV viral load.

CONCLUSION:

The high rates of IGRA conversion seen among HIV-infected postpartum women in our study are similar to those of other groups at high risk for M. tuberculosis infection. This has important implications for M. tuberculosis infection screening strategies and provision of preventive therapy for the health of women and their infants.

PMID:
26056103
PMCID:
PMC5316410
DOI:
10.5588/ijtld.14.0878
[Indexed for MEDLINE]
Free PMC Article

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