Pillay T, Khan M, Moodley J, Adhikari M, Coovadia H
Department of Paediatrics and Child Health, University of Natal, Nelson R Mandela Medical School, KwaZulu Natal, Durban, South Africa.
Lancet Infect Dis. 2004 Mar;4(3):155-65. doi: 10.1016/S1473-3099(04)00939-9.
Tuberculosis is the commonest HIV-1-related disease and the most frequent cause of mortality in young women in endemic regions. Tuberculosis and HIV-1 are independent risk factors for maternal mortality and adverse perinatal outcomes, and in combination have a greater impact on these parameters than their individual effects. In referral health centres in southern Africa around one-sixth of all maternal deaths are due to tuberculosis/HIV-1 coinfection. One-third (37%) of HIV-1-infected mothers with tuberculosis are severely immunocompromised, with CD4 counts of fewer than 200 cells/microL compared with 14-19% in mothers recruited into major mother-to-child intervention trials in Europe. Babies born to mothers with tuberculosis/HIV-1 also have higher rates of prematurity, low birthweight, and intrauterine growth restriction. Transmission rates of HIV-1 from mother to infant are around 25-45% in resource-limited settings, while that for mother-to-child-transmission of tuberculosis is 15% within 3 weeks of birth. We highlight this emergent problem, and discuss the dilemmas associated with diagnosis and management of pregnant HIV-1-infected mothers with tuberculosis, and their newborn babies.
结核病是最常见的与HIV-1相关的疾病，也是流行地区年轻女性最常见的死亡原因。结核病和HIV-1是孕产妇死亡和不良围产期结局的独立危险因素，两者共同作用对这些指标的影响大于各自单独的影响。在非洲南部的转诊医疗中心，约六分之一的孕产妇死亡是由结核病/HIV-1合并感染所致。三分之一（37%）感染HIV-1且患有结核病的母亲免疫功能严重受损，其CD4细胞计数低于200个/微升，而在欧洲主要的母婴干预试验中招募的母亲中这一比例为14%-19%。结核病/HIV-1感染母亲所生的婴儿早产、低出生体重和宫内生长受限的发生率也较高。在资源有限的环境中，HIV-1的母婴传播率约为25%-45%，而结核病的母婴传播率在出生后3周内为15%。我们强调这一新出现的问题，并讨论与诊断和管理感染HIV-1的结核病孕妇及其新生儿相关的困境。
