Tuberculosis Disease during Pregnancy and Treatment Outcomes in HIV-Infected and Uninfected Women at a Referral Hospital in Cape Town

Tuberculosis during pregnancy and treatment outcomes are poorly defined in high prevalence tuberculosis and HIV settings. A prospective cohort study of pregnant and postpartum women identified to be routinely on antituberculosis treatment was conducted at Tygerberg Hospital, Cape Town, South Africa,...

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Vydáno v:	PloS one Ročník 11; číslo 11; s. e0164249
Hlavní autoři:	Bekker, Adrie, Schaaf, Hendrik S., Draper, Heather R., Kriel, Magdalena, Hesseling, Anneke C.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Public Library of Science 03.11.2016 Public Library of Science (PLoS)
Témata:	Adult Analysis Antitubercular agents Biology and Life Sciences Birth weight Births Childrens health Clinical outcomes Cohort Studies Disease Drug therapy Fatalities Female Health sciences HIV HIV infections HIV Infections - complications HIV patients Hospitals Human immunodeficiency virus Humans Infant mortality Infants Infections Lentivirus Low birth weight Lymphatic system Maternal mortality Medical diagnosis Medical treatment Medicine Medicine and Health Sciences Microscopy Missing data Mortality Mycobacterium Neonates Newborn babies Newborn infants Obstetrics Patient outcomes People and Places Postpartum Pregnancy Pregnancy Complications, Infectious - drug therapy Pregnant women Prospective Studies Referral and Consultation Regression models Retroviridae South Africa Treatment Outcome Tuberculosis Tuberculosis - complications Tuberculosis - drug therapy Tutu, Desmond Womens health South Africa Switzerland
ISSN:	1932-6203, 1932-6203
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Shrnutí:	Tuberculosis during pregnancy and treatment outcomes are poorly defined in high prevalence tuberculosis and HIV settings. A prospective cohort study of pregnant and postpartum women identified to be routinely on antituberculosis treatment was conducted at Tygerberg Hospital, Cape Town, South Africa, from January 2011 through December 2011. Maternal tuberculosis disease spectrum and tuberculosis-exposed newborns were characterized by maternal HIV status. Maternal tuberculosis treatment outcomes were documented and a multivariable regression model identified predictors of unfavourable tuberculosis treatment outcomes. Infant outcomes were also described. Seventy-four women with tuberculosis, 53 (72%) HIV-infected, were consecutively enrolled; 35 (47%) were diagnosed at delivery or postpartum and 22 (30%) of women reported previous antituberculosis treatment. HIV-infected women were 5.67 times more likely to have extrapulmonary tuberculosis (95% CI 1.18-27.25, p = 0.03). All 5 maternal deaths were amongst HIV-infected women. Birth outcomes were available for 75 newborns (2 sets of twins, missing data for 1 stillbirth). Of the 75 newborns, 49 (65%) were premature and 44 (59%) were low birth weight (LBW; <2500 grams). All 6 infants who died and the 4 stillbirths were born to HIV-infected women. Unfavourable tuberculosis treatment outcomes were documented in 33/74 (45%) women. Unfavourable maternal tuberculosis outcome was associated with delivery of LBW infants (OR 3.83; 95% CI 1.40-10.53, p = 0.009). A large number of pregnant women with tuberculosis presented at a provincial referral hospital. All maternal and infant deaths occurred in HIV-infected women and their newborns. Maternal tuberculosis treatment outcomes were poor.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 Competing Interests: The authors have declared that no competing interests exist. Conceptualization: AB ACH HSS. Formal analysis: AB HRD. Investigation: AB MK. Methodology: AB HRD. Writing – original draft: AB. Writing – review & editing: AB HSS HRD MK ACH.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0164249