HIV-TB Coinfection among 57 Million Pregnant Women, Obstetric Complications, Alcohol Use, Drug Abuse, and Depression.

Dorian Fernandez,Janelle Davis,Jason L Salemi,Imoleayo Salami,Omonike A Olaleye,Hamisu M Salihu,Justin Babino,Kiara K Spooner,Aisha Kazeem,Laquiesha Carter,Florence Mbah,Abreah Ash

doi:10.1155/2018/5896901

Dorian Fernandez, Janelle Davis + Show 10 more

Open Access

https://doi.org/10.1155/2018/5896901

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Abstract

Objective HIV and tuberculosis represent diseases of major public health importance worldwide. Very little is known about HIV-TB coinfection among pregnant women, especially from industrialized settings. In this study, we examined the association between TB, HIV, and HIV-TB coinfection among pregnant mothers and obstetric complications, alcohol use, drug abuse, and depression. Method We examined inpatient hospital discharges in the United States from January 1, 2002, through December 31, 2014. We employed multivariable survey logistic regression to generate adjusted estimates for the association between infection status and study outcomes. Results We analyzed approximately 57 million records of pregnant women and their delivery information. HIV-TB coinfection was associated with the highest risks for several obstetric complications, alcohol use, and drug abuse. The risk for alcohol abuse was more than twice as high among HIV-monoinfected as compared to TB-monoinfected mothers. That risk gap more than doubled with HIV-TB coinfection. Both HIV-monoinfected and HIV-TB coinfected mothers experienced similarly increased risks for depression. Conclusions Mothers with HIV-TB coinfection experienced relatively heightened risks for obstetric complications, alcohol use, and drug abuse. The findings of this study underscore the importance of augmenting and enhancing social and structural support systems for HIV-TB coinfected pregnant women.

Highlights

Human Immunodeficiency Virus (HIV) and tuberculosis (TB) disease represent health issues of major public importance worldwide
The rates of HIV and HIV-TB coinfection were highest among black mothers, while TB monoinfection was most prevalent in Hispanics
It is noteworthy that the rate of TB among HIV-positive mothers was 150.23/100,000 in the population we analyzed, which was 21 times as high when compared to the rate of TB in the entire population of pregnant women analyzed

Summary

Introduction

Human Immunodeficiency Virus (HIV) and tuberculosis (TB) disease represent health issues of major public importance worldwide. One in three individuals is infected with Mycobacterium tuberculosis globally, and HIV is the main risk factor of active tuberculosis disease, increasing the risk of latent TB reactivation 20-fold [1]. Tuberculosis kills more than 1 million women per year, and it is estimated that 646 million women and girls are already infected with tuberculosis [2]. Among women aged 15–44 years in developing countries, tuberculosis is the third most common cause of morbidity and mortality combined and kills more women than any other infectious disease, including malaria and AIDS [3]. HIV-TB coinfected individuals are at greater risk for relapse following treatment as well as increased chances of drug resistance to anti-TB drugs [4,5,6,7,8]. Even in industrialized settings with good healthcare access and antiretroviral therapy (ART) availability, HIV-TB coinfection is associated with high mortality [9]

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