南非开普敦 HIV 阳性孕妇的结核病负担。

Burden of tuberculosis in HIV-positive pregnant women in Cape Town, South Africa.

机构信息

Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.

Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa, Institute for Global Health, University College London, London, UK, Centre for Infectious Diseases Research-AFRICA, University of Cape Town, Cape Town, South Africa.

出版信息

Int J Tuberc Lung Dis. 2018 Jul 1;22(7):760-765. doi: 10.5588/ijtld.17.0448.

DOI:10.5588/ijtld.17.0448

PMID:29914601

Abstract

BACKGROUND

The burden of active tuberculosis (TB) in pregnancy compared with preconception and postpartum is unclear, particularly with universal antiretroviral therapy (ART) initiation in pregnancy.

METHODS

We retrospectively compared active TB incidence in the 18 months preconception, during pregnancy and up to 6 months postpartum in human immunodeficiency virus (HIV) positive women attending antenatal care at a primary health care facility in Cape Town from 2013 to 2014.

RESULTS

Among 1513 women (4116 person-years [py]), 1489 (98.4%) received lifelong ART in pregnancy, and 79 TB episodes were identified. Unadjusted TB incidence rates (IR) preconception, during pregnancy and postpartum were 2466 (95%CI 1863-3202), 1127 (95% CI 600-1928) and 1447 (95% CI 694-2661) per 100 000 py, respectively. Adjusting for age and CD4 count at first antenatal visit and ART status, TB risk was lower during pregnancy (incidence rate ratio [IRR] 0.17 vs. preconception, 95%CI 0.09-0.31) and increased slightly postpartum (IRR 1.31 vs. pregnancy, 95%CI 0.56-3.07).

CONCLUSION

Among HIV-positive women in South Africa, the TB burden preconception, during pregnancy and postpartum was substantial. The risk of TB during pregnancy was lower than preconception, but increased slightly postpartum; this represents missed opportunities for diagnosis, prevention and control. Improved TB prevention strategies and integrated care for HIV-positive women and their children are needed.

摘要

背景

与孕前和产后相比，妊娠期活动性结核病（TB）的负担尚不清楚，尤其是在妊娠期间普遍开始抗逆转录病毒治疗（ART）的情况下。

方法

我们回顾性比较了 2013 年至 2014 年在开普敦的一家初级保健机构接受产前护理的 HIV 阳性妇女在妊娠前 18 个月、妊娠期间和产后 6 个月内活动性 TB 的发生率。

结果

在 1513 名妇女（4116 人年）中，1489 名（98.4%）在妊娠期间接受了终身 ART，发现 79 例 TB 发作。未调整的 TB 发病率（IR）在妊娠前、妊娠中和产后分别为 2466（95%CI 1863-3202）、1127（95%CI 600-1928）和 1447（95%CI 694-2661）/100000 人年。调整首次产前检查时的年龄、CD4 计数和 ART 状况后，妊娠期间 TB 风险较低（发病率比[IRR]0.17，95%CI 0.09-0.31），产后略有增加（IRR 1.31，95%CI 0.56-3.07）。