Maternal tuberculosis: A risk factor for mother-to-child transmission of human immunodeficiency virus

Amita Gupta, Ramesh Bhosale, Arti Kinikar, Nikhil Gupte, Renu Bharadwaj, Anju Kagal, Suvarna Joshi, Medha Khandekar, Alaka Karmarkar, Vandana Kulkarni, Jayagowri Sastry, Vidya Mave, Nishi Suryavanshi, Madhuri Thakar, Smita Kulkarni, Srikanth Tripathy, Pradeep Sambarey, Sandesh Patil, Ramesh Paranjape, Robert C BollingerArun Jamkar

Research output: Contribution to journalArticle

Abstract

Background. Maternal human immunodeficiency virus (HIV) RNA load, CD4 cell count, breast-feeding, antiretroviral use, and malaria are well-established factors associated with mother-to-child transmission (MTCT) of HIV; the role of maternal tuberculosis (TB), however, has not been well established. Methods. The study population was 783 HIV-infected Indian mother-infant pair participants in randomized and ancillary HIV-infected cohorts of the Six Week Extended-Dose Nevirapine (SWEN) Study, a study comparing extended nevirapine versus single-dose nevirapine, to reduce MTCT of HIV among breast-fed infants. Using multivariable logistic regression, we assessed the impact of maternal TB occurring during pregnancy and through 12 months after delivery on risk of MTCT. Results. Of 783 mothers, 3 had prevalent TB and 30 had incident TB at 12 months after delivery. Of 33 mothers with TB, 10 (30%) transmitted HIV to their infants in comparison with 87 of 750 mothers without TB (12%; odds ratio [OR], 3.31; 95% confidence interval [CI], 1.53-7.29; P = .02). In multivariable analysis, maternal TB was associated with 2.51-fold (95% CI, 1.05-6.02; P = .04) increased odds of HIV transmission adjusting for maternal factors (viral load, CD4 cell count, and antiretroviral therapy) and infant factors (breast-feeding duration, infant nevirapine administration, gestational age, and birth weight) associated with MTCT of HIV. Conclusions. Maternal TB is associated with increased MTCT of HIV. Prevention of TB among HIV-infected mothers should be a high priority for communities with significant HIV/TB burden.

Original languageEnglish (US)
Pages (from-to)358-363
Number of pages6
JournalJournal of Infectious Diseases
Volume203
Issue number3
DOIs
StatePublished - Feb 1 2011

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Tuberculosis
Mothers
HIV
Nevirapine
CD4 Lymphocyte Count
Breast Feeding
Confidence Intervals
Viral Load
Birth Weight
Malaria
Gestational Age
Breast
Logistic Models
Odds Ratio
RNA

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Allergy

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Maternal tuberculosis : A risk factor for mother-to-child transmission of human immunodeficiency virus. / Gupta, Amita; Bhosale, Ramesh; Kinikar, Arti; Gupte, Nikhil; Bharadwaj, Renu; Kagal, Anju; Joshi, Suvarna; Khandekar, Medha; Karmarkar, Alaka; Kulkarni, Vandana; Sastry, Jayagowri; Mave, Vidya; Suryavanshi, Nishi; Thakar, Madhuri; Kulkarni, Smita; Tripathy, Srikanth; Sambarey, Pradeep; Patil, Sandesh; Paranjape, Ramesh; Bollinger, Robert C; Jamkar, Arun.

In: Journal of Infectious Diseases, Vol. 203, No. 3, 01.02.2011, p. 358-363.

Research output: Contribution to journalArticle

Gupta, A, Bhosale, R, Kinikar, A, Gupte, N, Bharadwaj, R, Kagal, A, Joshi, S, Khandekar, M, Karmarkar, A, Kulkarni, V, Sastry, J, Mave, V, Suryavanshi, N, Thakar, M, Kulkarni, S, Tripathy, S, Sambarey, P, Patil, S, Paranjape, R, Bollinger, RC & Jamkar, A 2011, 'Maternal tuberculosis: A risk factor for mother-to-child transmission of human immunodeficiency virus', Journal of Infectious Diseases, vol. 203, no. 3, pp. 358-363. https://doi.org/10.1093/infdis/jiq064
Gupta, Amita ; Bhosale, Ramesh ; Kinikar, Arti ; Gupte, Nikhil ; Bharadwaj, Renu ; Kagal, Anju ; Joshi, Suvarna ; Khandekar, Medha ; Karmarkar, Alaka ; Kulkarni, Vandana ; Sastry, Jayagowri ; Mave, Vidya ; Suryavanshi, Nishi ; Thakar, Madhuri ; Kulkarni, Smita ; Tripathy, Srikanth ; Sambarey, Pradeep ; Patil, Sandesh ; Paranjape, Ramesh ; Bollinger, Robert C ; Jamkar, Arun. / Maternal tuberculosis : A risk factor for mother-to-child transmission of human immunodeficiency virus. In: Journal of Infectious Diseases. 2011 ; Vol. 203, No. 3. pp. 358-363.
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abstract = "Background. Maternal human immunodeficiency virus (HIV) RNA load, CD4 cell count, breast-feeding, antiretroviral use, and malaria are well-established factors associated with mother-to-child transmission (MTCT) of HIV; the role of maternal tuberculosis (TB), however, has not been well established. Methods. The study population was 783 HIV-infected Indian mother-infant pair participants in randomized and ancillary HIV-infected cohorts of the Six Week Extended-Dose Nevirapine (SWEN) Study, a study comparing extended nevirapine versus single-dose nevirapine, to reduce MTCT of HIV among breast-fed infants. Using multivariable logistic regression, we assessed the impact of maternal TB occurring during pregnancy and through 12 months after delivery on risk of MTCT. Results. Of 783 mothers, 3 had prevalent TB and 30 had incident TB at 12 months after delivery. Of 33 mothers with TB, 10 (30{\%}) transmitted HIV to their infants in comparison with 87 of 750 mothers without TB (12{\%}; odds ratio [OR], 3.31; 95{\%} confidence interval [CI], 1.53-7.29; P = .02). In multivariable analysis, maternal TB was associated with 2.51-fold (95{\%} CI, 1.05-6.02; P = .04) increased odds of HIV transmission adjusting for maternal factors (viral load, CD4 cell count, and antiretroviral therapy) and infant factors (breast-feeding duration, infant nevirapine administration, gestational age, and birth weight) associated with MTCT of HIV. Conclusions. Maternal TB is associated with increased MTCT of HIV. Prevention of TB among HIV-infected mothers should be a high priority for communities with significant HIV/TB burden.",
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T2 - A risk factor for mother-to-child transmission of human immunodeficiency virus

AU - Gupta, Amita

AU - Bhosale, Ramesh

AU - Kinikar, Arti

AU - Gupte, Nikhil

AU - Bharadwaj, Renu

AU - Kagal, Anju

AU - Joshi, Suvarna

AU - Khandekar, Medha

AU - Karmarkar, Alaka

AU - Kulkarni, Vandana

AU - Sastry, Jayagowri

AU - Mave, Vidya

AU - Suryavanshi, Nishi

AU - Thakar, Madhuri

AU - Kulkarni, Smita

AU - Tripathy, Srikanth

AU - Sambarey, Pradeep

AU - Patil, Sandesh

AU - Paranjape, Ramesh

AU - Bollinger, Robert C

AU - Jamkar, Arun

PY - 2011/2/1

Y1 - 2011/2/1

N2 - Background. Maternal human immunodeficiency virus (HIV) RNA load, CD4 cell count, breast-feeding, antiretroviral use, and malaria are well-established factors associated with mother-to-child transmission (MTCT) of HIV; the role of maternal tuberculosis (TB), however, has not been well established. Methods. The study population was 783 HIV-infected Indian mother-infant pair participants in randomized and ancillary HIV-infected cohorts of the Six Week Extended-Dose Nevirapine (SWEN) Study, a study comparing extended nevirapine versus single-dose nevirapine, to reduce MTCT of HIV among breast-fed infants. Using multivariable logistic regression, we assessed the impact of maternal TB occurring during pregnancy and through 12 months after delivery on risk of MTCT. Results. Of 783 mothers, 3 had prevalent TB and 30 had incident TB at 12 months after delivery. Of 33 mothers with TB, 10 (30%) transmitted HIV to their infants in comparison with 87 of 750 mothers without TB (12%; odds ratio [OR], 3.31; 95% confidence interval [CI], 1.53-7.29; P = .02). In multivariable analysis, maternal TB was associated with 2.51-fold (95% CI, 1.05-6.02; P = .04) increased odds of HIV transmission adjusting for maternal factors (viral load, CD4 cell count, and antiretroviral therapy) and infant factors (breast-feeding duration, infant nevirapine administration, gestational age, and birth weight) associated with MTCT of HIV. Conclusions. Maternal TB is associated with increased MTCT of HIV. Prevention of TB among HIV-infected mothers should be a high priority for communities with significant HIV/TB burden.

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