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, Adriana
dc.contributor.authorAaron, Lisa
dc.contributor.authorMmbaga, Blandina
dc.contributor.authorKabugho, Enid
dc.contributor.authorMasheto, Gaerolwe
dc.contributor.authorGausi, Kamunkhwala
dc.contributor.authorGupta, Amita
dc.date.accessioned2023-03-21T18:58:15Z
dc.date.available2023-03-21T18:58:15Z
dc.date.issued2021
dc.description.abstractPregnancy 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. 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. 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. 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_US
dc.identifier.citationWeinberg, A., Aaron, L., Montepiedra, G., Sterling, T. R., Browning, R., Mmbaga, B., ... & IMPAACT P1078 study team Shao Alisa Nyati Mandisa Louw Jeanne Kakhu Tebogo J Chipato Tsungai Stranix-Chibanda Lynda Suryavanshi Nishi Tongprasert Fuanglada de Vaal Celeste. (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.https://doi.org/10.1093/cid/ciaa1083en_US
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/8266
dc.language.isoenen_US
dc.publisherClinical infectious diseasesen_US
dc.subjectLatent tuberculosis infectionen_US
dc.subjectIsoniazid preventive therapyen_US
dc.subjectInterferon gamma response assaysen_US
dc.subjectHIV infectionen_US
dc.titleEffects of Pregnancy and Isoniazid Preventive Therapy on Mycobacterium tuberculosis Interferon Gamma Response Assays in Women With HIVen_US
dc.typeArticleen_US
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