title: Incidence and correlates of tuberculosis IGRA conversion among HIV-infected postpartum women.
abstract: METHODS
  Prevention of maternal-to-child transmission program at a tertiary care hospital in Nairobi, Kenya. The risk of acquiring Mycobacterium tuberculosis infection among peripartum human immunodeficiency virus (HIV) infected women is poorly defined.
  
  
  OBJECTIVE
  To determine the incidence of and co-factors for interferon-gamma release assay (IGRA) conversion among postpartum HIV-infected women using T-SPOT.TB.
  
  
  METHODS
  We used data and cryopreserved peripheral blood mononuclear cells from a historical cohort of HIV-infected women enrolled at 32 weeks' gestation and followed for 1 year postpartum between 1999 and 2005.
  
  
  RESULTS
  Of 89 women initially IGRA-negative during pregnancy, 11 (12.4%) became positive, 53 (59.5%) remained negative and 25 (28.1%) were indeterminate at 1 year postpartum. Mean interferon-gamma (IFN-γ) response among converters increased from ~1 to >50 spot-forming cells/well (P = 0.015). IGRA conversion was significantly associated with partner HIV infection, flush toilets, maternal illness and cough during follow-up, but not maternal CD4 count or HIV viral load.
  
  
  CONCLUSIONS
  The high rates of IGRA conversion seen among HIV-infected postpartum women in our study are similar to those of other groups at high risk for M. tuberculosis infection. This has important implications for M. tuberculosis infection screening strategies and provision of preventive therapy for the health of women and their infants.
authors.affiliation: Department of Epidemiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: S
authors.initials: S
authors.lastname: Jonnalagadda
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: LaCourse
authors.affiliation: Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: P
authors.initials: P
authors.lastname: Otieno
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya; Institute for Immunology and Informatics and Department of Cell and Molecular Biology, University of Rhode Island, Providence, Rhode Island, USA.
authors.forename: B
authors.initials: B
authors.lastname: Lohman-Payne
authors.affiliation: Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: E
authors.initials: E
authors.lastname: Maleche-Obimbo
authors.affiliation: Emory School of Medicine and Children's Healthcare of Atlanta, Division of Pediatric Infectious Disease, Atlanta, Georgia, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Cranmer
authors.affiliation: Department of Epidemiology, Department of Medicine, University of Washington, Seattle, Washington, USA; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Global Health, University of Washington, Seattle, USA; Department of Global Health, University of Washington, Seattle, USA.
authors.forename: G C
authors.initials: GC
authors.lastname: John-Stewart
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000706:statistics & numerical data*; D007630:Kenya / Q000453:epidemiology; D055985:Latent Tuberculosis / Q000175:diagnosis*; D007963:Leukocytes, Mononuclear; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity*; D049590:Postpartum Period; D011247:Pregnancy; D062606:Tertiary Care Centers; D019562:Viral Load; D055815:Young Adult