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Subclinical tuberculosis and adverse infant outcomes in pregnant women with HIV

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BACKGROUND: Tuberculosis (TB) in pregnant women with HIV is associated with adverse maternal and infant outcomes. Previous studies have described a substantial prevalence of subclinical TB in this group, but little is known about the impact of subclinical TB on maternal and pediatric outcomes.

METHODS: The Tshepiso Study recruited 235 HIV-infected pregnant women with TB (and matched HIV-positive, TB-negative pregnant controls), in Soweto, South Africa, from 2011 to 2014. During enrolment screening, some women initially recruited as controls were subsequently diagnosed with prevalent TB. We therefore assessed the prevalence of subclinical TB, associated participant characteristics and outcomes.

RESULTS: Of 162 women initially recruited as TB-negative controls, seven (4.3%) were found to have TB on sputum culture. All seven had negative WHO symptom screens, and six (86%) were smear-negative. Of their seven infants, one was diagnosed with TB, and three (43%) experienced complications compared to zero infants with TB and 11% experiencing complications in the control group of TB-negative mothers (P = 0.045).

CONCLUSION: We discovered an appreciable prevalence of subclinical TB in HIV-infected pregnant women in Soweto, which had not been detected by screening algorithms based solely on symptoms. Infants of HIV-infected mothers with subclinical TB appear to have a higher risk of adverse outcomes than those of TB-negative mothers.
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Document Type: Research Article

Affiliations: 1: The Center for TB Research, Johns Hopkins University School of Medicine, Baltimore, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 2: The Center for TB Research, Johns Hopkins University School of Medicine, Baltimore, MD 3: Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg 4: Perinatal HIV Research Unit (PHRU), South African Medical Research Council Soweto, Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg South Africa 5: The Center for TB Research, Johns Hopkins University School of Medicine, Baltimore, MD, Perinatal HIV Research Unit (PHRU), South African Medical Research Council Soweto, Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg South Africa

Publication date: July 1, 2020

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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