Perinatal tuberculosis and HIV-1: considerations for resource-limited settings

Area of Science:

• Public Health
• Infectious Diseases
• Maternal Health

Background:

• Tuberculosis (TB) is the most common HIV-1-related illness and a leading cause of mortality in young women in TB-endemic regions.
• Tuberculosis and HIV-1 are independent risk factors for maternal mortality and adverse perinatal outcomes.
• Coinfection with TB and HIV-1 exacerbates these risks, contributing to approximately one-sixth of maternal deaths in Southern African referral centers.

Purpose of the Study:

• To highlight the emergent problem of tuberculosis and HIV-1 coinfection in pregnant women.
• To discuss the diagnostic and management challenges associated with this coinfection in mothers and newborns.
• To underscore the severe impact of coinfection on maternal and infant health outcomes.

Main Methods:

• The study reviews existing data on tuberculosis and HIV-1 coinfection in pregnant women.
• It analyzes maternal mortality rates and perinatal outcomes in affected populations.
• It compares the immune status (CD4 counts) of coinfected mothers with HIV-1-infected mothers in intervention trials.

Main Results:

• Coinfection leads to significantly higher rates of maternal mortality and adverse perinatal outcomes compared to individual infections.
• A substantial proportion (37%) of HIV-1-infected mothers with TB are severely immunocompromised (CD4 < 200 cells/microL).
• Infants born to coinfected mothers experience increased rates of prematurity, low birthweight, and intrauterine growth restriction.

Conclusions:

• Tuberculosis/HIV-1 coinfection presents a critical health challenge in endemic regions, particularly impacting young women.
• Management of pregnant, HIV-1-infected mothers with TB and their newborns is complex and requires specialized approaches.
• Early diagnosis and effective management strategies are crucial to mitigate the severe consequences of this coinfection.