The pregnancy surveillance tactics for women with HIV-related tuberculosis
Introduction. Recently, there are more pregnant women who are HIV positive, and there are cases of tuberculosis (TB) among them. The paper analyzes the course of pregnancy of women with HIV-related TB, the basic ways to optimize the surveillance of pregnancy of women with HIV-related TB, depending on the presence of active TB.
Similar to HIV infection, the incidence of TB is the highest among women of reproductive age, so there naturally arises the problem of HIV-related TB among pregnant women and obstetric patients [Savula, 2011].
Today, TB remains the most common cause of mortality and morbidity among HIV-infected patients and is the leading cause of maternal mortality in high HIV prevalence areas [Martin, 2012].
Given the increased rates of obstetric and perinatal complications among pregnant women with HIV-related TB, today there is an open and urgent matter of possibility of saving and carrying a pregnancy of such women, as well as determining the pregnancy surveillance tactics in case it has been saved.
Materials and methods. There has been analyzed the course of pregnancy of 158 HIV-infected women, including patients with TB, who were divided into five groups. The developed design anticipated two investigation phases:
Phase I was the investigation of assessment of the obstetric and perinatal complications among pregnant women with HIV-related TB.
Phase II was the investigation of assessment of the effectiveness of the proposed algorithm for pregnancy surveillance and methods of treatment of HIV-infected pregnant women without active TB, but with residual changes after pulmonary TB.
Results. The investigation found that the presence of active TB during pregnancy of HIV-infected women is a high-risk factor for pregnancy, delivery and perinatal complications, and therefore a high-risk factor for maternal and perinatal mortality.
In turn, immune defenses are low during pregnancy and delivery. This worsens the course of both HIV infection and TB, promoting the development of more advanced stages of these diseases.
According to the results obtained during the investigation, one may state that if there is the presence of active TB infection in an HIV-infected pregnant woman, saving and carrying a pregnancy is not desirable due to the high risk of obstetric and perinatal complications.
In case of residual changes after pulmonary TB in an HIV-infected pregnant woman, carrying a pregnancy is possible under the joint supervision of an obstetrician-gynecologist, TB doctor and an infectious disease specialist. Clinical management tactics for this category of women should include a timely screening for active TB, as well as prophylactic and antiretroviral therapy during pregnancy to prevent mother-to-child transmission of HIV.
Introducing the algorithm for surveillance of a pregnancy of an HIV-infected woman depending on the presence of active TB will decrease the incidence of obstetric and perinatal complications, which in turn would improve the maternal and perinatal mortality rates in Ukraine.
Conclusions. 1. established that the active presence of tuberculosis during pregnancy in HIV-infected women have a high risk factor for complications of pregnancy, childbirth and perinatal complications. In turn, pregnancy and childbirth reduces the immune defenses than worsen the course of HIV infection and tuberculosis. 2. It can be argued that the active presence of tuberculosis in HIV-infected pregnant women, preservation and pregnancy is not desirable because of the high risk of obstetric and perinatal complications. 3. In the case of the remaining amendments suffering of tuberculosis in HIV-infected pregnant pregnancy possible under the joint supervision of an obstetrician-gynecologist, a TB doctor and an infectious diseases doctor. Clinical management of this category of women should include timely screening for active tuberculosis, pregnancy rates for destination preventive therapy, prevention of relapse of tuberculosis, as well as receiving antiretroviral treatment to prevent HIV transmission from mother to child.