Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India

Background: Accurate tuberculosis infection (TBI) tests are critical for pregnant women, especially those with HIV, who have a high risk of TB disease. Methods: We enrolled interferon gamma release assay (IGRA)+ pregnant women with and without HIV in a longitudinal study, followed up at delivery and...

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Autores principales:	Ramesh Bhosale, Mallika Alexander, Prasad Deshpande, Vandana Kulkarni, Nikhil Gupte, Amita Gupta, Jyoti Mathad
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Tubercular Infection (TBI) Interferon Gamma Release Assay (IGRA) Tuberculin Skin Test (TST) pregnancy, Human Immune Deficiency Virus (HIV) Interferon Gamma (IFN-γ) Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/5f7d9713a53f4af3a6f895c1d091efe3
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spelling	oai:doaj.org-article:5f7d9713a53f4af3a6f895c1d091efe32021-11-30T04:14:10ZStages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India1201-971210.1016/j.ijid.2021.09.010https://doaj.org/article/5f7d9713a53f4af3a6f895c1d091efe32021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1201971221007232https://doaj.org/toc/1201-9712Background: Accurate tuberculosis infection (TBI) tests are critical for pregnant women, especially those with HIV, who have a high risk of TB disease. Methods: We enrolled interferon gamma release assay (IGRA)+ pregnant women with and without HIV in a longitudinal study, followed up at delivery and 6 months postpartum. Tuberculin skin test (TST) and IGRA were compared by HIV status at each timepoint. Results: Of 165 enrolled IGRA+ pregnant women: 35 (21%) had HIV and were on antiretroviral therapy with median CD4 of 476 (IQR 399–586). Compared to antepartum, significantly fewer women remained IGRA+ at delivery [HIV+ n=21/35 (62%, p=0.009); HIV- n=100/130 (77%, p=0.002)] and postpartum [HIV+ n=30/35 (87%, p=0.03); HIV– n=116/130 (89%, p=0.01)]. IGRA/TST discordance was high in pregnant women (HIV+: 51%; HIV-: 25%). Median IFN-γ was lowest for all women at delivery; significantly lower in women with HIV at all timepoints compared to women without HIV. TB incidence was 50/ 1000 person-years and 18/1000 person-years among women with and without HIV respectively. Conclusions: Pregnancy affects TBI test results and reduces IFN-γ response to M. tuberculosis stimulation. Despite adequate CD4 counts, women with HIV express less IFN-γ than women without HIV, which may explain the high TB incidence in postpartum women with HIV.Ramesh BhosaleMallika AlexanderPrasad DeshpandeVandana KulkarniNikhil GupteAmita GuptaJyoti MathadElsevierarticleTubercular Infection (TBI)Interferon Gamma Release Assay (IGRA)Tuberculin Skin Test (TST)pregnancy, Human Immune Deficiency Virus (HIV)Interferon Gamma (IFN-γ)Infectious and parasitic diseasesRC109-216ENInternational Journal of Infectious Diseases, Vol 112, Iss , Pp 205-211 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Tubercular Infection (TBI) Interferon Gamma Release Assay (IGRA) Tuberculin Skin Test (TST) pregnancy, Human Immune Deficiency Virus (HIV) Interferon Gamma (IFN-γ) Infectious and parasitic diseases RC109-216
spellingShingle	Tubercular Infection (TBI) Interferon Gamma Release Assay (IGRA) Tuberculin Skin Test (TST) pregnancy, Human Immune Deficiency Virus (HIV) Interferon Gamma (IFN-γ) Infectious and parasitic diseases RC109-216 Ramesh Bhosale Mallika Alexander Prasad Deshpande Vandana Kulkarni Nikhil Gupte Amita Gupta Jyoti Mathad Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India
description	Background: Accurate tuberculosis infection (TBI) tests are critical for pregnant women, especially those with HIV, who have a high risk of TB disease. Methods: We enrolled interferon gamma release assay (IGRA)+ pregnant women with and without HIV in a longitudinal study, followed up at delivery and 6 months postpartum. Tuberculin skin test (TST) and IGRA were compared by HIV status at each timepoint. Results: Of 165 enrolled IGRA+ pregnant women: 35 (21%) had HIV and were on antiretroviral therapy with median CD4 of 476 (IQR 399–586). Compared to antepartum, significantly fewer women remained IGRA+ at delivery [HIV+ n=21/35 (62%, p=0.009); HIV- n=100/130 (77%, p=0.002)] and postpartum [HIV+ n=30/35 (87%, p=0.03); HIV– n=116/130 (89%, p=0.01)]. IGRA/TST discordance was high in pregnant women (HIV+: 51%; HIV-: 25%). Median IFN-γ was lowest for all women at delivery; significantly lower in women with HIV at all timepoints compared to women without HIV. TB incidence was 50/ 1000 person-years and 18/1000 person-years among women with and without HIV respectively. Conclusions: Pregnancy affects TBI test results and reduces IFN-γ response to M. tuberculosis stimulation. Despite adequate CD4 counts, women with HIV express less IFN-γ than women without HIV, which may explain the high TB incidence in postpartum women with HIV.
format	article
author	Ramesh Bhosale Mallika Alexander Prasad Deshpande Vandana Kulkarni Nikhil Gupte Amita Gupta Jyoti Mathad
author_facet	Ramesh Bhosale Mallika Alexander Prasad Deshpande Vandana Kulkarni Nikhil Gupte Amita Gupta Jyoti Mathad
author_sort	Ramesh Bhosale
title	Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India
title_short	Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India
title_full	Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India
title_fullStr	Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India
title_full_unstemmed	Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India
title_sort	stages of pregnancy and hiv affect diagnosis of tuberculosis infection and mycobacterium tuberculosis (mtb)-induced immune response: findings from prachiti, a cohort study in pune, india
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/5f7d9713a53f4af3a6f895c1d091efe3
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Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India

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