Effects of Pregnancy and Isoniazid Preventive Therapy onMycobacterium tuberculosisInterferon Gamma Response Assays in Women With HIV
| Autor: | Enid Kabugho, Paolo Denti, David W. Haas, Gaerolwe Masheto, Gerhard Theron, Shilpa Naik, Diane Costello, Jyoti S. Mathad, Amita Gupta, Sylvia M LaCourse, Sarah Bradford, Marie F. Pierre, Bonnie Zimmer, Kamunkhwala Gausi, Timothy R. Sterling, Renee Browning, Katie McCarthy, Adriana Weinberg, Tichaona Vhembo, Impaact Study Team, Lisa Aaron, Grace Montepiedra, Blandina T. Mmbaga, Savita Pahwa |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty Tuberculosis medicine.medical_treatment Tuberculin HIV Infections Mycobacterium tuberculosis Interferon-gamma 03 medical and health sciences 0302 clinical medicine Latent Tuberculosis Pregnancy Internal medicine Isoniazid medicine Humans 030212 general & internal medicine Online only Articles Latent tuberculosis biology Tuberculin Test business.industry bacterial infections and mycoses medicine.disease biology.organism_classification 030104 developmental biology Infectious Diseases Interpersonal psychotherapy Female business Interferon-gamma Release Tests Postpartum period medicine.drug |
| Zdroj: | Clin Infect Dis |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciaa1083 |
| Popis: | BackgroundPregnancy is accompanied by immune suppression. We hypothesized that Mycobacterium tuberculosis-specific inflammatory responses used to identify latent tuberculosis infection (LTBI) lose positivity during pregnancy. We also hypothesized that isoniazid preventive therapy (IPT) may revert LTBI diagnoses because of its sterilizing activity.Methods944 women with human immunodeficiency virus infection (HIV) participating in a randomized, double-blind, placebo-controlled study comparing 28 weeks of IPT antepartum versus postpartum, were tested by QuantiFERON-gold-in-tube (QGIT) antepartum and by QGIT and tuberculin skin test (TST) at delivery and postpartum. Serial QGIT positivity was assessed by logistic regression using generalized estimating equations.ResultsFrom entry to delivery, 68 (24%) of 284 QGIT-positive women reverted to QGIT-negative or indeterminate. Of these, 42 (62%) recovered QGIT positivity postpartum. The loss of QGIT positivity during pregnancy was explained by decreased interferon gamma (IFNγ) production in response to TB antigen and/or mitogen. At delivery, LTBI was identified by QGIT in 205 women and by TST in 113 women. Corresponding numbers postpartum were 229 and 122 women. QGIT and TST kappa agreement coefficients were 0.4 and 0.5, respectively. Among QGIT-positive women antepartum or at delivery, 34 (12%) reverted to QGIT-negative after IPT. There were no differences between women who initiated IPT antepartum or postpartum.ConclusionsDecreased IFNγ responses in pregnancy reduced QGIT positivity, suggesting that this test cannot reliably rule out LTBI during pregnancy. TST was less affected by pregnancy, but had lower positivity compared to QGIT at all time points. IPT was associated with loss of QGIT positivity, the potential clinical consequences of which need to be investigated. |
| Databáze: | OpenAIRE |
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