title: Maternal tuberculosis: a risk factor for mother-to-child transmission of human immunodeficiency virus.
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.
authors.affiliation: Center for Clinical Global Health Education, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. agupta25@jhmi.edu
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
authors.forename: Ramesh
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authors.lastname: Bhosale
authors.forename: Arti
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authors.lastname: Kinikar
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authors.lastname: Gupte
authors.forename: Renu
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authors.lastname: Bharadwaj
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authors.lastname: Kagal
authors.forename: Suvarna
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authors.lastname: Joshi
authors.forename: Medha
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authors.lastname: Khandekar
authors.forename: Alaka
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authors.lastname: Karmarkar
authors.forename: Vandana
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authors.lastname: Kulkarni
authors.forename: Jayagowri
authors.initials: J
authors.lastname: Sastry
authors.forename: Vidya
authors.initials: V
authors.lastname: Mave
authors.forename: Nishi
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authors.lastname: Suryavanshi
authors.forename: Madhuri
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authors.lastname: Thakar
authors.forename: Smita
authors.initials: S
authors.lastname: Kulkarni
authors.forename: Srikanth
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authors.lastname: Tripathy
authors.forename: Pradeep
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authors.lastname: Sambarey
authors.forename: Sandesh
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authors.lastname: Patil
authors.forename: Ramesh
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authors.lastname: Paranjape
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
authors.forename: Arun
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authors.lastname: Jamkar
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008875:Middle Aged; D019829:Nevirapine / Q000627:therapeutic use; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology* / Q000821:virology*; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000635:transmission*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine