Isoniazid Preventive Therapy and Pregnancy Outcomes in Women Living With Human Immunodeficiency Virus in the Tshepiso Cohort
Isoniazid Preventive Therapy and Pregnancy Outcomes in Women Living With Human Immunodeficiency Virus in the Tshepiso Cohort
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DOI：
10.1093/cid/ciz1024
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发表时间：
2020-09-15
影响因子：
11.8
通讯作者：
Martinson, Neil
中科院分区：
文献类型：
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作者：
Salazar-Austin, Nicole;Cohn, Silvia;Martinson, Neil
背景 怀孕和人类免疫缺陷病毒 (HIV) 都会增加患结核病的风险，从而导致孕产妇、怀孕和婴儿的结局不佳。异烟肼预防性治疗 (IPT) 可以降低高负担环境中 HIV 感染者的死亡率，但最近发现在怀孕期间开始时与不良妊娠结局相关。 方法 在这项二次分析中，我们使用多变量逻辑回归来评估 IPT 暴露与不良妊娠结局（胎儿死亡、早产、低出生体重、先天性异常）之间的关联。 2011 年至 2014 年南非索韦托的结核病。结果 共有 151 名女性入组，妊娠结局已知； 69 人 (46%) 报告在怀孕期间开始进行 IPT。在 69 名接受过 IPT 的女性中，有 11 名 (16%) 出现了不良妊娠结局，而 23 名 (28%) 名未接受过 IPT 的女性则出现了不良妊娠结局。在控制了母亲年龄、CD4 计数、病毒载量、抗逆转录病毒治疗方案、体重指数和贫血后，未接触过 IPT 的女性出现不良妊娠结局的调整后几率为 2.5 倍（95% 置信区间，1.0-6.5；P = 0.048）。 结论 在控制了人口、临床和 HIV 相关因素后，妊娠期间的 IPT 接触与妊娠结局并不呈负相关。这些结果让我们确信 IPT 可以在妊娠中期或晚期安全使用。需要进行更多的研究来评估孕期 IPT 和新的短程结核病预防疗法的安全性。在这项对感染人类免疫缺陷病毒 (HIV) 的孕妇进行的二次分析中，无论是否接触过异烟肼，以预防孕期结核病，在控制人口、临床和 HIV 相关混杂因素后，我们没有观察到异烟肼预防性治疗的使用与妊娠结局之间存在负相关。
Background Both pregnancy and human immunodeficiency virus (HIV) increase the risk of tuberculosis disease, which results in poor maternal, pregnancy, and infant outcomes. Isoniazid preventive therapy (IPT) reduces mortality among individuals living with HIV in high-burden settings but has recently been associated with adverse pregnancy outcomes when initiated during pregnancy.Methods In this secondary analysis, we used multivariable logistic regression to evaluate the association between IPT exposure and adverse pregnancy outcomes (fetal demise, prematurity, low birth weight, congenital anomaly) in pregnant women living with HIV enrolled as controls in the Tshepiso study, a prospective observational cohort of pregnant women living with HIV with and without tuberculosis disease in Soweto, South Africa, from 2011-2014.Results There were 151 women enrolled with known pregnancy outcomes; 69 (46%) reported IPT initiation during pregnancy. Of the 69 IPT-exposed women, 11 (16%) had an adverse pregnancy outcome compared with 23 (28%) IPT-unexposed women. The adjusted odds of having an adverse pregnancy outcome was 2.5 (95% confidence interval, 1.0-6.5; P = .048) times higher in IPT-unexposed women compared with IPT-exposed women after controlling for maternal age, CD4 count, viral load, antiretroviral regimen, body mass index, and anemia.Conclusions IPT exposure during pregnancy was not negatively associated with pregnancy outcomes after controlling for demographic, clinical, and HIV-related factors. These results provide some reassurance that IPT can be safely used in the second or third trimester of pregnancy. Additional research is needed to evaluate the safety of IPT and new short-course tuberculosis preventive therapies during pregnancy.In this secondary analysis of pregnant women living human immunodeficiency virus (HIV) with and without isoniazid exposure for tuberculosis prevention during pregnancy, we did not observe a negative association between isoniazid preventive therapy use and pregnancy outcomes after controlling for demographic, clinical, and HIV-related confounding factors.