Perinatal tuberculosis and HIV-1: considerations for resource-limited settings.
Tuberculosis is the commonest HIV-1-related disease and the most frequent cause of mortality in young women in endemic regions. Tuberculosis and HIV-1 are independent risk factors for maternal mortality and adverse perinatal outcomes, and in combination have a greater impact on these parameters than their individual effects. In referral health centres in southern Africa around one-sixth of all maternal deaths are due to tuberculosis/HIV-1 coinfection. One-third (37%) of HIV-1-infected mothers with tuberculosis are severely immunocompromised, with CD4 counts of fewer than 200 cells/microL compared with 14-19% in mothers recruited into major mother-to-child intervention trials in Europe. Babies born to mothers with tuberculosis/HIV-1 also have higher rates of prematurity, low birthweight, and intrauterine growth restriction. Transmission rates of HIV-1 from mother to infant are around 25-45% in resource-limited settings, while that for mother-to-child-transmission of tuberculosis is 15% within 3 weeks of birth. We highlight this emergent problem, and discuss the dilemmas associated with diagnosis and management of pregnant HIV-1-infected mothers with tuberculosis, and their newborn babies.
Department of Paediatrics and Child Health, University of Natal, Nelson R Mandela Medical School, KwaZulu Natal, Durban, South Africa. tpillay@gwmail.jr2.ox.ac.uk
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T
Pillay
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Khan
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J
Moodley
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M
Adhikari
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Coovadia
D000353:Africa, Southern; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008428:Maternal Mortality; D018743:Perinatal Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000401:mortality; D011256:Pregnancy Outcome; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000401:mortality / Q000635:transmission*; D019562:Viral Load
D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents