Vertical transmission of Mycobacterium tuberculosisin KwaZulu Natal: impact of HIV-1 co-infection
DESIGN: Prospective case series study of 82 HIV-1-infected and 25 non-infected pregnant mothers, King Edward VIII Hospital, KwaZulu Natal, South Africa.
RESULTS: Perinatal mortality in HIV-1/TB diseased mothers was 85/1000 and associated with maternal anaemia (P = 0.02); 46% of newborns were premature, 66% low birth weight and 49% intrauterine growth restricted. These were significantly higher than overall hospital rates (P < 0.01, OR 4.8, 95%CI 3.2–7.0). Sites of detection of maternal TB, distribution of bacteriologically-proven TB, obstetric comorbidity and perinatal morbidity were similar in HIV-1-infected and non-infected mothers. VTRTB was detected in 16 newborns (16%), occurring similarly in bacteriologically-proven and suspected maternal TB disease, with no difference between HIV-1-infected and non-infected mothers. Eleven newborns with VTRTB were HIV-1 exposed; 64% acquired HIV-1 and died from rapidly progressive disease by 10 months of age. HIV-1-infected mothers and their exposed newborns had significantly lower CD4 counts. No association between perinatal maternal viral load, CD4 count or VTRTB was detected.
CONCLUSION: Mothers with TB disease in pregnancy are at risk for significant perinatal morbidity, mortality and VTRTB.
Document Type: Regular Paper
Affiliations: 1: Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; and the Department of Paediatrics, University of Natal, Durban, South Africa 2: Department of Medical Microbiology, University of Natal, Durban, South Africa 3: Department of Paediatrics, University of Natal, Durban, South Africa; and the Pregnancy and Hypertension Unit, Medical Research Council, Durban, South Africa 4: Department of Paediatrics, University of Natal, Durban, South Africa 5: Department of Obstetrics and Gynaecology, University of Natal, Durban, South Africa 6: Pregnancy and Hypertension Unit, Medical Research Council, Durban, South Africa 7: King George V Hospital, Durban, South Africa 8: Medical School, University of Massachussetts, Worcester, Massachussetts, USA
Publication date: January 1, 2004
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