title: TB-HIV co-infection among pregnant women in Karnataka, South India: A case series.
abstract: Tuberculosis (TB) is a significant contributor to mortality in HIV-infected patients. Concurrent TB infection is also a significant contributing factor to maternal mortality in human immunodeficiency virus (HIV)-infected pregnant women. Studies addressing the outcomes of TB and HIV co-infection among pregnant women are generally infrequent. Although limited, the records maintained by the Revised National Tuberculosis Control Programme (RNTCP) and the National AIDS Control Programme (NACP) in Karnataka State, Southern India provide information about the numbers of pregnant women who are co-infected with TB and HIV and their pregnancy outcomes. We reviewed the data and conducted this study to understand how TB-HIV co-infection influences the outcomes of pregnancy in this setting. We sought to determine the incidence and treatment and delivery outcomes of TB-HIV co-infected pregnant women in programmatic settings in Karnataka State in southern India. The study participants were all the HIV-infected pregnant women who were screened for tuberculosis under the NACP from 2008 to 2012. For the purposes of this study, the program staff in the field gathered the data regarding on treatment and delivery outcomes of pregnant women. A total of seventeen pregnant women with TB-HIV co-infection were identified among 3,165,729 pregnant women (for an incidence of 5.4 per million pregnancies). The median age of these pregnant women was 24 years, and majority were primiparous women with WHO HIV stage III disease and were on a stavudine-based ART regimen. The maternal mortality rates were 18% before delivery and 24% after delivery. The abortion rate was 24%, and the neonatal mortality rate was 10%. The anti-tuberculosis treatment and anti-retroviral treatment outcome mortality rates were 30% and 53%, respectively. Although the incidence of TB among the HIV-infected pregnant women was marginally less than that among the non-HIV-infected women, the delivery outcomes were relatively poorer. The current strategy for the management of TB among the HIV-positive pregnant women needs urgent review.
authors.affiliation: State Tuberculosis Office, Bangalore, India.
authors.forename: Shastri
authors.initials: S
authors.lastname: Suresh
authors.affiliation: ESIC Medical College and PGIMSR, Bangalore, India. Electronic address: sharathbn@yahoo.com.
authors.forename: Burugina N
authors.initials: BN
authors.lastname: Sharath
authors.affiliation: St. John's Medical College Hospital, Bangalore, India.
authors.forename: Shet
authors.initials: S
authors.lastname: Anita
authors.affiliation: Karnataka State AIDS Prevention Society, Bangalore, India.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Lalitha
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Tripathy J
authors.initials: TJ
authors.lastname: Prasad
authors.affiliation: National AIDS Control Organization, New Delhi, India.
authors.forename: Bharat B
authors.initials: BB
authors.lastname: Rewari
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D060085:Coinfection / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011256:Pregnancy Outcome; D016019:Survival Analysis; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents
keywords: Outcomes; Pregnant women; TB and HIV