Tuberculosis Preventive Treatment for Pregnant People With HIV in South Africa: A Modeling Analysis of Clinical Benefits and Risks.
| Title: | Tuberculosis Preventive Treatment for Pregnant People With HIV in South Africa: A Modeling Analysis of Clinical Benefits and Risks. |
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| Authors: | Rosen LV; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.; Thielking AM; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.; Dugdale CM; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.; Montepiedra G; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.; Kalk E; Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa.; Kim S; Frontier Science Foundation, Brookline, Massachusetts, USA.; LaCourse SM; Department of Global Health, University of Washington, Seattle, Washington, USA.; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.; Department of Epidemiology, University of Washington, Seattle, Washington, USA.; Mathad JS; Department of Medicine, Center for Global Health, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA.; Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA.; Freedberg KA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.; Horsburgh CR; Boston University School of Public Health, Boston, Massachusetts, USA.; Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.; Paltiel AD; Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, USA.; Wood R; Desmond Tutu Health Foundation, Mowbray, Cape Town, Western Cape, South Africa.; Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.; Ciaranello AL; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.; Reddy KP; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. |
| Source: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2025 Oct 06; Vol. 81 (3), pp. 613-622. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Oxford University Press Country of Publication: United States NLM ID: 9203213 Publication Model: Print Cited Medium: Internet ISSN: 1537-6591 (Electronic) Linking ISSN: 10584838 NLM ISO Abbreviation: Clin Infect Dis Subsets: MEDLINE |
| Imprint Name(s): | Publication: Jan. 2011- : Oxford : Oxford University Press; Original Publication: Chicago, IL : The University of Chicago Press, c1992- |
| MeSH Terms: | Tuberculosis*/prevention & control ; Tuberculosis*/epidemiology ; HIV Infections*/complications ; HIV Infections*/drug therapy ; Antitubercular Agents*/therapeutic use ; Antitubercular Agents*/adverse effects ; Antitubercular Agents*/administration & dosage ; Pregnancy Complications, Infectious*/prevention & control ; Pregnancy Complications, Infectious*/drug therapy; South Africa/epidemiology ; Isoniazid/therapeutic use ; Isoniazid/adverse effects ; Isoniazid/administration & dosage ; Rifampin/analogs & derivatives ; Rifampin/therapeutic use ; Rifampin/adverse effects ; Rifampin/administration & dosage ; Chemoprevention/methods ; Anti-HIV Agents/therapeutic use ; Humans ; Female ; Pregnancy ; Infant, Newborn ; Adult ; Pregnancy Outcome ; Risk Assessment |
| Abstract: | Background: Although prior studies of tuberculosis-preventive treatment (TPT) for pregnant people with human immunodeficiency virus (PPWH) report conflicting adverse pregnancy outcome (APO) risks, international guidelines recommend TPT for PPWH.; Methods: We used a microsimulation model to evaluate 5 TPT strategies among PPWH receiving antiretroviral therapy in South Africa: No TPT; 6 months of isoniazid (6H) or 3 months of isoniazid-rifapentine (3HP) during pregnancy (Immediate 6H or Immediate 3HP) or post partum (Deferred 6H or Deferred 3HP). The primary outcomes were maternal, fetal/infant, and combined deaths from causes potentially influenced by TPT (maternal tuberculosis, maternal hepatotoxicity, stillbirth, low birth weight [LBW], and infant tuberculosis). Tuberculosis during pregnancy confers 250% and 81% higher modeled risks of stillbirth and LBW, respectively. In lower-risk or higher-risk scenarios, immediate TPT confers 38% lower or 92% higher risks of stillbirth and 16% lower or 35% higher risks of LBW.; Results: Immediate TPT would minimize deaths among PPWH. When TPT confers higher stillbirth and LBW risks, immediate TPT would produce the most combined maternal and fetal/infant deaths, even with low maternal CD4 cell count and high tuberculosis incidence. If immediate TPT yields a |
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| Grant Information: | U01 TW012626 United States TW FIC NIH HHS; U01 TW012626 United States NH NIH HHS; UM1 AI068616 United States AI NIAID NIH HHS; R01 AI093269 United States AI NIAID NIH HHS; R01 AI058736 United States AI NIAID NIH HHS; MGH James and Audrey Foster Research Scholar Award; K08 HD101342 United States HD NICHD NIH HHS; R37 HD079214 United States HD NICHD NIH HHS; R37 AI058736 United States AI NIAID NIH HHS |
| Contributed Indexing: | Keywords: HIV; adverse pregnancy outcome; pregnancy; tuberculosis; tuberculosis preventive treatment |
| Substance Nomenclature: | 0 (Antitubercular Agents); V83O1VOZ8L (Isoniazid); VJT6J7R4TR (Rifampin); XJM390A33U (rifapentine); 0 (Anti-HIV Agents) |
| Entry Date(s): | Date Created: 20241115 Date Completed: 20251006 Latest Revision: 20260516 |
| Update Code: | 20260516 |
| PubMed Central ID: | PMC12497950 |
| DOI: | 10.1093/cid/ciae508 |
| PMID: | 39544107 |
| Database: | MEDLINE |
Journal Article