Maternal HIV Status and Risk of Infant Mycobacterium Tuberculosis Infection as Measured by Tuberculin Skin Test-Reference-Cited by-同舟云学术

Maternal HIV Status and Risk of Infant Mycobacterium Tuberculosis Infection as Measured by Tuberculin Skin Test

Published:2023-11-22 Issue: Volume: Page:
ISSN:0891-3668
Container-title:Pediatric Infectious Disease Journal
language:en
Short-container-title:

Author:

Mecha Jerphason¹^ORCID,Escudero Jaclyn N.²^ORCID,Richardson Barbra A.²³,Maleche-Obimbo Elizabeth²⁴,Matemo Daniel⁵,Kinuthia John²⁵⁶,John-Stewart Grace²⁷⁸⁹,LaCourse Sylvia M.²⁷⁸^ORCID

Affiliation:

1. Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya

2. Department of Global Health, University of Washington, Seattle, Washington

3. Department of Biostatistics, University of Washington, Seattle, Washington

4. Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya

5. Research and Programs, Kenyatta National Hospital, Nairobi, Kenya

6. Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya

7. Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington

8. Department of Epidemiology, University of Washington, Seattle, Washington; and

9. Department of Pediatrics, University of Washington, Seattle, Washington.

Abstract

Background: The effect of maternal HIV on infant Mycobacterium tuberculosis (Mtb) infection risk is not well-characterized. Methods: Pregnant women with/without HIV and their infants were enrolled in a longitudinal cohort in Kenya. Mothers had interferon gamma-release assays (QFT-Plus) and tuberculin skin tests (TST) at enrollment in pregnancy; children underwent TST at 12 and 24 months of age. We estimated the incidence and correlates of infant TST-positivity using Cox proportional hazards regression. Results: Among 322 infants, 170 (53%) were HIV-exposed and 152 (47%) were HIV-unexposed. Median enrollment age was 6.6 weeks [interquartile range (IQR): 6.1–10.0]; most received Bacillus Calmette-Guerin (320, 99%). Thirty-nine (12%) mothers were TST-positive; 102 (32%) were QFT-Plus-positive. Among HIV-exposed infants, 154 (95%) received antiretrovirals for HIV prevention and 141 (83%) of their mothers ever received isoniazid preventive therapy (IPT). Cumulative 24-month infant Mtb infection incidence was 3.6/100 person-years (PY) [95% confidence interval (CI): 2.4–5.5/100 PY]; 5.4/100 PY in HIV-exposed infants (10%, 17/170) versus 1.7/100 PY in HIV-unexposed infants (3.3%, 5/152) [hazard ratio (HR): 3.1 (95% CI: 1.2–8.5)]. More TST conversions occurred in the first versus second year of life [5.8 vs. 2.0/100 PY; HR: 2.9 (95% CI: 1.0–10.1)]. Infant TST-positivity was associated with maternal TST-positivity [HR: 2.9 (95% CI: 1.1–7.4)], but not QFT-Plus-positivity. Among HIV-exposed children, Mtb infection incidence was similar regardless of maternal IPT. Conclusions: Mtb infection incidence (by TST) by 24 months of age was ~3-fold higher among HIV-exposed children, despite high maternal IPT uptake. Overall, more TST conversions occurred in the first 12 months compared to 12–24 months of age, similar in both HIV-exposed and HIV-unexposed children.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Infectious Diseases,Microbiology (medical),Pediatrics, Perinatology and Child Health

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