Jonnalagadda S, LaCourse S M, Otieno P, Lohman-Payne B, Maleche-Obimbo E, Cranmer L M, John-Stewart G C
Department of Epidemiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
Int J Tuberc Lung Dis. 2015 Jul;19(7):792-8. doi: 10.5588/ijtld.14.0878.
Prevention of maternal-to-child transmission program at a tertiary care hospital in Nairobi, Kenya. The risk of acquiring Mycobacterium tuberculosis infection among peripartum human immunodeficiency virus (HIV) infected women is poorly defined.
To determine the incidence of and co-factors for interferon-gamma release assay (IGRA) conversion among postpartum HIV-infected women using T-SPOT.TB.
We used data and cryopreserved peripheral blood mononuclear cells from a historical cohort of HIV-infected women enrolled at 32 weeks' gestation and followed for 1 year postpartum between 1999 and 2005.
Of 89 women initially IGRA-negative during pregnancy, 11 (12.4%) became positive, 53 (59.5%) remained negative and 25 (28.1%) were indeterminate at 1 year postpartum. Mean interferon-gamma (IFN-γ) response among converters increased from ~1 to >50 spot-forming cells/well (P = 0.015). IGRA conversion was significantly associated with partner HIV infection, flush toilets, maternal illness and cough during follow-up, but not maternal CD4 count or HIV viral load.
The high rates of IGRA conversion seen among HIV-infected postpartum women in our study are similar to those of other groups at high risk for M. tuberculosis infection. This has important implications for M. tuberculosis infection screening strategies and provision of preventive therapy for the health of women and their infants.
肯尼亚内罗毕一家三级护理医院的母婴传播预防项目。围产期感染人类免疫缺陷病毒（HIV）的女性感染结核分枝杆菌的风险尚不明确。
使用T-SPOT.TB检测产后感染HIV女性中干扰素-γ释放试验（IGRA）转换的发生率及相关因素。
我们使用了1999年至2005年期间入组的一组感染HIV女性的历史队列数据和冻存的外周血单个核细胞，这些女性在妊娠32周时入组，产后随访1年。
89名孕期最初IGRA阴性的女性中，11名（12.4%）产后1年转为阳性，53名（59.5%）仍为阴性，25名（28.1%）结果不确定。转换者的平均干扰素-γ（IFN-γ）反应从约1个斑点形成细胞/孔增加至>50个斑点形成细胞/孔（P = 0.015）。IGRA转换与伴侣感染HIV、抽水马桶、随访期间母亲患病和咳嗽显著相关，但与母亲的CD4细胞计数或HIV病毒载量无关。
我们研究中感染HIV的产后女性中IGRA转换率很高，与其他结核分枝杆菌感染高危组相似。这对结核分枝杆菌感染筛查策略以及为妇女及其婴儿的健康提供预防性治疗具有重要意义。
