Effects of pregnancy and isoniazid preventive therapy on mycobacterium tuberculosis interferon gamma response assays in women with HIV

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dc.contributor.authorWeinberg, Adrianaen_ZA
dc.contributor.authorAaron, Lisaen_ZA
dc.contributor.authorMontepiedra, Graceen_ZA
dc.contributor.authorSterling, Timothy R.en_ZA
dc.contributor.authorBrowning, Reneeen_ZA
dc.contributor.authorMmbaga, Blandinaen_ZA
dc.contributor.authorVhembo, Tichaonaen_ZA
dc.contributor.authorNaik, Shilpaen_ZA
dc.contributor.authorKabugho, Eniden_ZA
dc.contributor.authorMasheto, Gaerolween_ZA
dc.contributor.authorPahwa, Savitaen_ZA
dc.contributor.authorMathad, Jyoti S.en_ZA
dc.contributor.authorLaCourse, Sylvia M.en_ZA
dc.contributor.authorMcCarthy, Katieen_ZA
dc.contributor.authorBradford, Sarahen_ZA
dc.contributor.authorTheron, Gerharden_ZA
dc.contributor.authorCostello, Dianeen_ZA
dc.contributor.authorZimmer, Bonnieen_ZA
dc.contributor.authorPierre, Marie F.en_ZA
dc.contributor.authorGausi, Kamunkhwalaen_ZA
dc.contributor.authorDenti, Paoloen_ZA
dc.contributor.authorHaas, David W.en_ZA
dc.contributor.authorGupta, Amitaen_ZA
dc.date.accessioned2022-06-02T12:24:39Zen_ZA
dc.date.available2022-06-02T12:24:39Zen_ZA
dc.date.issued2020-07en_ZA
dc.descriptionCITATION: Weinberg, A. et al. 2021. Effects of Pregnancy and Isoniazid Preventive Therapy on Mycobacterium tuberculosis Interferon Gamma Response Assays in Women With HIV. Clinical infectious diseases, 73(9): e3555–e3562. doi:10.1093/cid/ciaa1083en_ZA
dc.descriptionThe original publication is available at https://academic.oup.com/cid/en_ZA
dc.description.abstractBackground Pregnancy is accompanied by immune suppression. We hypothesized that Mycobacterium tuberculosis-specific inflammatory responses used to identify latent tuberculosis infection (LTBI) lose positivity during pregnancy. We also hypothesized that isoniazid preventive therapy (IPT) may revert LTBI diagnoses because of its sterilizing activity. Methods 944 women with human immunodeficiency virus infection (HIV) participating in a randomized, double-blind, placebo-controlled study comparing 28 weeks of IPT antepartum versus postpartum, were tested by QuantiFERON-gold-in-tube (QGIT) antepartum and by QGIT and tuberculin skin test (TST) at delivery and postpartum. Serial QGIT positivity was assessed by logistic regression using generalized estimating equations. Results From entry to delivery, 68 (24%) of 284 QGIT-positive women reverted to QGIT-negative or indeterminate. Of these, 42 (62%) recovered QGIT positivity postpartum. The loss of QGIT positivity during pregnancy was explained by decreased interferon gamma (IFNγ) production in response to TB antigen and/or mitogen. At delivery, LTBI was identified by QGIT in 205 women and by TST in 113 women. Corresponding numbers postpartum were 229 and 122 women. QGIT and TST kappa agreement coefficients were 0.4 and 0.5, respectively. Among QGIT-positive women antepartum or at delivery, 34 (12%) reverted to QGIT-negative after IPT. There were no differences between women who initiated IPT antepartum or postpartum. Conclusions Decreased IFNγ responses in pregnancy reduced QGIT positivity, suggesting that this test cannot reliably rule out LTBI during pregnancy. TST was less affected by pregnancy, but had lower positivity compared to QGIT at all time points. IPT was associated with loss of QGIT positivity, the potential clinical consequences of which need to be investigated.en_ZA
dc.description.urihttps://academic.oup.com/cid/article/73/9/e3555/5877271?login=trueen_ZA
dc.description.versionPublishers versionen_ZA
dc.format.extent8 pagesen_ZA
dc.identifier.citationWeinberg, A. et al. 2021. Effects of Pregnancy and Isoniazid Preventive Therapy on Mycobacterium tuberculosis Interferon Gamma Response Assays in Women With HIV. Clinical infectious diseases, 73(9): e3555–e3562. doi:10.1093/cid/ciaa1083en_ZA
dc.identifier.issn1537-6591 (online)en_ZA
dc.identifier.issn1058-4838 (print)en_ZA
dc.identifier.otherdoi:10.1093/cid/ciaa1083en_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/125304en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherOxford University Pressen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectLatent virus diseasesen_ZA
dc.subjectPregnancy -- Immunological aspectsen_ZA
dc.subjectPreventive therapyen_ZA
dc.subjectIsoniaziden_ZA
dc.subjectOpportunistic infectionsen_ZA
dc.titleEffects of pregnancy and isoniazid preventive therapy on mycobacterium tuberculosis interferon gamma response assays in women with HIVen_ZA
dc.typeArticleen_ZA
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