Brief Report: High Programmatic Isoniazid Preventive Therapy (IPT) Use in Pregnancy Among HIV-Infected Women.
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 09 2019
01 09 2019
Historique:
entrez:
14
8
2019
pubmed:
14
8
2019
medline:
15
4
2020
Statut:
ppublish
Résumé
The World Health Organization recommends isoniazid preventive therapy (IPT) for people living with HIV (PLHIV) to prevent tuberculosis (TB), including pregnant women. Recent trial results suggest increased adverse pregnancy outcomes associated with IPT during pregnancy. Data are limited regarding programmatic IPT use in pregnant PLHIV. We assessed previous programmatic IPT during pregnancy among HIV-infected mothers on enrollment to an infant TB prevention trial in Kenya. Pregnancy IPT use was assessed by the estimated conception date assuming 38 weeks of gestation. Correlates of initiation and completion were analyzed by relative risk regression, using generalized linear models with log link and Poisson family adjusted for IPT initiation year. Between August 15, 2016, to June 6, 2018, 300 HIV-infected women enrolled at 6 weeks postpartum. Two hundred twenty-four (74.7%) women reported previous IPT, of whom 155/224 (69.2%) had any pregnancy IPT use. Forty-five (29.0%) initiated preconception extending into early pregnancy, 41 (26.5%) initiated and completed during pregnancy, and 69 (44.5%) initiated in pregnancy and extended into early postpartum. The median gestational age at IPT pregnancy initiation was 15.1 weeks (interquartile range 8.3-28.4). Pregnancy/early postpartum IPT initiation was associated with new pregnancy HIV diagnosis [adjusted relative risk 1.9 95% confidence interval (CI): 1.6 to 2.2, P < 0.001]. Six-month IPT completion rates were high [147/160 (91.9%)] among women with sufficient time to complete before trial enrollment and similar among preconception or during pregnancy initiators [adjusted relative risk 0.93 (95% confidence interval: 0.83 to 1.04, P = 0.19)]. Programmatic IPT use was high in pregnant PLHIV, with frequent periconception and early pregnancy initiation. Programmatic surveillance could provide further insights on pregnancy IPT implementation and maternal and infant safety outcomes.
Sections du résumé
BACKGROUND
The World Health Organization recommends isoniazid preventive therapy (IPT) for people living with HIV (PLHIV) to prevent tuberculosis (TB), including pregnant women. Recent trial results suggest increased adverse pregnancy outcomes associated with IPT during pregnancy. Data are limited regarding programmatic IPT use in pregnant PLHIV.
METHODS
We assessed previous programmatic IPT during pregnancy among HIV-infected mothers on enrollment to an infant TB prevention trial in Kenya. Pregnancy IPT use was assessed by the estimated conception date assuming 38 weeks of gestation. Correlates of initiation and completion were analyzed by relative risk regression, using generalized linear models with log link and Poisson family adjusted for IPT initiation year.
RESULTS
Between August 15, 2016, to June 6, 2018, 300 HIV-infected women enrolled at 6 weeks postpartum. Two hundred twenty-four (74.7%) women reported previous IPT, of whom 155/224 (69.2%) had any pregnancy IPT use. Forty-five (29.0%) initiated preconception extending into early pregnancy, 41 (26.5%) initiated and completed during pregnancy, and 69 (44.5%) initiated in pregnancy and extended into early postpartum. The median gestational age at IPT pregnancy initiation was 15.1 weeks (interquartile range 8.3-28.4). Pregnancy/early postpartum IPT initiation was associated with new pregnancy HIV diagnosis [adjusted relative risk 1.9 95% confidence interval (CI): 1.6 to 2.2, P < 0.001]. Six-month IPT completion rates were high [147/160 (91.9%)] among women with sufficient time to complete before trial enrollment and similar among preconception or during pregnancy initiators [adjusted relative risk 0.93 (95% confidence interval: 0.83 to 1.04, P = 0.19)].
CONCLUSIONS
Programmatic IPT use was high in pregnant PLHIV, with frequent periconception and early pregnancy initiation. Programmatic surveillance could provide further insights on pregnancy IPT implementation and maternal and infant safety outcomes.
Identifiants
pubmed: 31408031
doi: 10.1097/QAI.0000000000002086
pii: 00126334-201909010-00007
pmc: PMC6697133
mid: NIHMS1527137
doi:
Substances chimiques
Antitubercular Agents
0
Isoniazid
V83O1VOZ8L
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
41-45Subventions
Organisme : NIAID NIH HHS
ID : K23 AI120793
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002319
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000423
Pays : United States
Références
Thorax. 2011 Feb;66(2):163-7
pubmed: 21148136
J Infect Dis. 2011 Feb 1;203(3):358-63
pubmed: 21208928
N Engl J Med. 2011 Jul 7;365(1):11-20
pubmed: 21732833
Clin Infect Dis. 2012 Dec;55(11):1532-49
pubmed: 22942202
AIDS. 2012 Oct 23;26(16):2039-52
pubmed: 22951634
Infect Dis Obstet Gynecol. 2013;2013:195637
pubmed: 23533318
Public Health Rep. 1989 Mar-Apr;104(2):151-5
pubmed: 2495549
J Acquir Immune Defic Syndr. 2014 Sep 1;67(1):e5-e11
pubmed: 25118796
Clin Infect Dis. 2016 Mar 15;62(6):761-769
pubmed: 26658057
Int J Tuberc Lung Dis. 2016 Jan;20(1):85-92
pubmed: 26688533
Clin Infect Dis. 2016 Nov 1;63(9):1227-1235
pubmed: 27461920
Lancet Infect Dis. 2016 Nov;16(11):1269-1278
pubmed: 27522233
Am Rev Respir Dis. 1989 Sep;140(3):700-5
pubmed: 2782741
Obstet Gynecol. 2017 May;129(5):967-968
pubmed: 28426616
Clin Infect Dis. 2017 Oct 15;65(8):1383-1387
pubmed: 29017245
Clin Infect Dis. 2018 Mar 5;66(6):921-929
pubmed: 29028970
Ann Am Thorac Soc. 2018 May;15(5):570-580
pubmed: 29393655
Int J Tuberc Lung Dis. 2018 Jun 1;22(6):596-605
pubmed: 29862942
J Int AIDS Soc. 2018 Jul;21(7):e25143
pubmed: 29972628
N Engl J Med. 2018 Sep 6;379(10):979-981
pubmed: 30037297
AIDS Behav. 2019 Jul;23(7):1689-1697
pubmed: 30415430
Int J Tuberc Lung Dis. 2018 Dec 1;22(12):1435-1442
pubmed: 30606315