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Global Health Matters

July - August, 2007  |  Volume 6, Issue 4

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.

An Indian TB patient looks at her chest x-ray.

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 Johns 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 Johns 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.