Abstract
The high burden of HIV and tuberculosis (TB) among pregnant women in South Africa contributes to a high maternal mortality rate. Isoniazid preventive therapy (IPT) is recommended for the prevention of active TB in HIV-infected individuals, including pregnant women. However, there are few data regarding IPT use in the latter, with concern regarding the concurrent use of IPT with nevirapine in pregnancy, as both treatments are hepatotoxic. The benefit and safety of IPT in HIV-infected pregnant women has not been established. We recommend a simplification of HIV and TB interventions by providing triple antiretroviral therapy to all HIV-infected pregnant women.
Highlights
The high burden of HIV and tuberculosis (TB) among pregnant women in South Africa contributes to a high maternal mortality rate
The treatment of latent TB infection (LTBI) reduced the risk of active TB by 32% (risk ratio (RR) 0.68; 95% confidence interval (CI) 0.54 - 0.85)
Despite antiretroviral therapy (ART) availability in the country, the recent maternal mortality survey showed that the majority of women who died from
Summary
TB prevention, diagnosis and treatment in HIV-infected pregnant women should be integrated into routine maternal healthcare services. It has been established that the use of IPT reduces the risk of active TB in HIV-infected individuals This is more pronounced in those with a positive tuberculin skin test (TST).[20,21] The most recent meta-analysis of the treatment of latent TB infection (LTBI) in HIV-infected individuals encompassed 12 trials and 8 578 HIV-infected participants.[20] Overall, the treatment of LTBI reduced the risk of active TB by 32% (risk ratio (RR) 0.68; 95% confidence interval (CI) 0.54 - 0.85). Experts recommend not initiating IPT at the same time as ART, but rather delaying initiation until stabilisation on ART, at approximately 3 months.[22,28]
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