International Journal of Infectious Diseases, Nov 1, 2021
Background: Accurate tuberculosis infection (TBI) tests are critical for pregnant women, especial... more Background: Accurate tuberculosis infection (TBI) tests are critical for pregnant women, especially those with HIV, who have a high risk of TB disease. Methods: We enrolled interferon gamma release assay (IGRA)+ pregnant women with and without HIV in a longitudinal study, followed up at delivery and 6 months postpartum. Tuberculin skin test (TST) and IGRA were compared by HIV status at each timepoint. Results: Of 165 enrolled IGRA+ pregnant women: 35 (21%) had HIV and were on antiretroviral therapy with median CD4 of 476 (IQR 399–586). Compared to antepartum, significantly fewer women remained IGRA+ at delivery [HIV+ n=21/35 (62%, p=0.009); HIV− n=100/130 (77%, p=0.002)] and postpartum [HIV+ n=30/35 (87%, p=0.03); HIV− n=116/130 (89%, p=0.01)]. IGRA/TST discordance was high in pregnant women (HIV+: 51%; HIV−: 25%). Median IFN-γ was lowest for all women at delivery; significantly lower in women with HIV at all timepoints compared to women without HIV. TB incidence was 50/ 1000 person-years and 18/1000 person-years among women with and without HIV respectively. Conclusions: Pregnancy affects TBI test results and reduces IFN-γ response to M. tuberculosis stimulation. Despite adequate CD4 counts, women with HIV express less IFN-γ than women without HIV, which may explain the high TB incidence in postpartum women with HIV.
JAIDS Journal of Acquired Immune Deficiency Syndromes
Background: Bacterial vaginosis (BV) is a highly prevalent disorder of the cervicovaginal microbi... more Background: Bacterial vaginosis (BV) is a highly prevalent disorder of the cervicovaginal microbiota. Molecular-BV may put women at increased risk for adverse reproductive and obstetric outcomes. We investigated the association of HIV and pregnancy on the vaginal microbiota and associations with molecular-BV in women of reproductive age from Pune, India. Setting: We studied vaginal samples from N = 170 women, including N = 44 nonpregnant HIV seronegative, N = 56 pregnant seronegative, N = 47 nonpregnant women with HIV (WWH), and N = 23 pregnant WWH, and collected data on clinical, behavioral, and demographic factors. Methods: We used 16S rRNA gene amplicon sequencing to characterize the composition of the vaginal microbiota. We classified the vaginal microbiota of these women into community state types based on bacterial composition and relative abundance and further categorized them into molecular-BV versus Lactobacillus-dominated states. To determine associations between pregnancy...
The American Journal of Tropical Medicine and Hygiene
ABSTRACT. Infection of HIV is associated with an increased diabetes risk, which also increases tu... more ABSTRACT. Infection of HIV is associated with an increased diabetes risk, which also increases tuberculosis risk. It is unknown if similar associations exist with gestational diabetes (GDM). We screened pregnant women living with and without HIV for GDM using oral glucose tolerance testing. In a subgroup of women with latent tuberculosis (positive interferon-gamma [IFN-γ] release assay), we used supernatants from tuberculosis antigen tubes to compare cytokine levels from women with and without GDM, matched by age and HIV status. Of 234 women, 21 (9%) had GDM, 13.9% living with HIV, and 6.5% without HIV (P = 0.06). Compared with women without GDM, women with GDM had lower median IFN-γ (19.1 versus 141.9 pg/mL, P = 0.03) and interleukin-2 (18.7 versus 249 pg/mL, P < 0.01). Our study suggests that HIV infection is associated with an increased risk of GDM, which is associated with decreased Mycobacterium tuberculosis immune responses. Gestational diabetes screening should be prioriti...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2021
A new tuberculosis diagnostic cartridge assay, which detects a 3-gene tuberculosis signature in w... more A new tuberculosis diagnostic cartridge assay, which detects a 3-gene tuberculosis signature in whole blood, was not diagnostic in women with maternal tuberculosis disease in India (AUC = 0.72). In a cohort of pregnant women, we identified a novel gene set for TB diagnosis (AUC = 0.97) and one for TB progression (AUC = 0.96).
OBJECTIVE There are limited studies on the association of HIV infection with systemic inflammatio... more OBJECTIVE There are limited studies on the association of HIV infection with systemic inflammation during pregnancy. DESIGN A cohort study (N = 220) of pregnant women with HIV (N = 70) (all on antiretroviral therapy) and without HIV (N = 150) were enrolled from an antenatal clinic in Pune, India. METHODS The following systemic inflammatory markers were measured in plasma samples using immunoassays: soluble CD163 (sCD163), soluble CD14 (sCD14), intestinal fatty acid-binding protein (I-FABP), C-reactive protein (CRP), alpha 1-acid glycoprotein (AGP), interferon-β (IFNβ), interferon-γ (IFNγ), interleukin (IL)-1β, IL-6, IL-13, IL-17A and tumor necrosis factor α (TNFα). Generalized estimating equation (GEE) and linear regression models were used to assess the association of HIV status with each inflammatory marker during pregnancy and by trimester, respectively. RESULTS Pregnant women with HIV had higher levels of markers for gut barrier dysfunction (I-FABP), monocyte activation (sCD14) and markers of systemic inflammation (IL-6 and TNFα), but surprisingly lower levels of AGP, an acute phase protein, compared to pregnant women without HIV, with some trimester-specific differences. CONCLUSIONS Our data show that women with HIV had higher levels of markers of gut barrier dysfunction, monocyte activation and systemic inflammation. These markers, some of which are associated with preterm birth, might help explain the increase in adverse birth outcomes in women with HIV and could suggest targets for potential interventions.
Formation of partnerships among young women and men in Pune district, MaharashtraThis report is t... more Formation of partnerships among young women and men in Pune district, MaharashtraThis report is the result of a collaborative study between the KEM Hospital Research Centre (KEMHRC), Pune and the Population Council, New Delhi, with support from the Hewlett and MacArthur Foundations. The survey instrument used in the study is available online at the Population Council website
Aside from their educational attainment economic activity levels and age at marriage little is kn... more Aside from their educational attainment economic activity levels and age at marriage little is known about the lives of young people in India especially the extent to which and the contexts in which they form romantic marital and other partnerships or the nature of these partnerships. At a time when Indias youth policy and reproductive and child health programmes have acknowledged the need to focus on youth it is central that these gaps in understanding are filled. In this context the KEM Hospital Research Centre and the Population Council conducted a study in Maharashtra in 2003-05 to obtain information on romantic and sexual partnership formation and sexual activity among young people (aged 15-24) through a large-scale community-based survey and related textual data gathering. (excerpt)
International Journal of Infectious Diseases, Nov 1, 2021
Background: Accurate tuberculosis infection (TBI) tests are critical for pregnant women, especial... more Background: Accurate tuberculosis infection (TBI) tests are critical for pregnant women, especially those with HIV, who have a high risk of TB disease. Methods: We enrolled interferon gamma release assay (IGRA)+ pregnant women with and without HIV in a longitudinal study, followed up at delivery and 6 months postpartum. Tuberculin skin test (TST) and IGRA were compared by HIV status at each timepoint. Results: Of 165 enrolled IGRA+ pregnant women: 35 (21%) had HIV and were on antiretroviral therapy with median CD4 of 476 (IQR 399–586). Compared to antepartum, significantly fewer women remained IGRA+ at delivery [HIV+ n=21/35 (62%, p=0.009); HIV− n=100/130 (77%, p=0.002)] and postpartum [HIV+ n=30/35 (87%, p=0.03); HIV− n=116/130 (89%, p=0.01)]. IGRA/TST discordance was high in pregnant women (HIV+: 51%; HIV−: 25%). Median IFN-γ was lowest for all women at delivery; significantly lower in women with HIV at all timepoints compared to women without HIV. TB incidence was 50/ 1000 person-years and 18/1000 person-years among women with and without HIV respectively. Conclusions: Pregnancy affects TBI test results and reduces IFN-γ response to M. tuberculosis stimulation. Despite adequate CD4 counts, women with HIV express less IFN-γ than women without HIV, which may explain the high TB incidence in postpartum women with HIV.
JAIDS Journal of Acquired Immune Deficiency Syndromes
Background: Bacterial vaginosis (BV) is a highly prevalent disorder of the cervicovaginal microbi... more Background: Bacterial vaginosis (BV) is a highly prevalent disorder of the cervicovaginal microbiota. Molecular-BV may put women at increased risk for adverse reproductive and obstetric outcomes. We investigated the association of HIV and pregnancy on the vaginal microbiota and associations with molecular-BV in women of reproductive age from Pune, India. Setting: We studied vaginal samples from N = 170 women, including N = 44 nonpregnant HIV seronegative, N = 56 pregnant seronegative, N = 47 nonpregnant women with HIV (WWH), and N = 23 pregnant WWH, and collected data on clinical, behavioral, and demographic factors. Methods: We used 16S rRNA gene amplicon sequencing to characterize the composition of the vaginal microbiota. We classified the vaginal microbiota of these women into community state types based on bacterial composition and relative abundance and further categorized them into molecular-BV versus Lactobacillus-dominated states. To determine associations between pregnancy...
The American Journal of Tropical Medicine and Hygiene
ABSTRACT. Infection of HIV is associated with an increased diabetes risk, which also increases tu... more ABSTRACT. Infection of HIV is associated with an increased diabetes risk, which also increases tuberculosis risk. It is unknown if similar associations exist with gestational diabetes (GDM). We screened pregnant women living with and without HIV for GDM using oral glucose tolerance testing. In a subgroup of women with latent tuberculosis (positive interferon-gamma [IFN-γ] release assay), we used supernatants from tuberculosis antigen tubes to compare cytokine levels from women with and without GDM, matched by age and HIV status. Of 234 women, 21 (9%) had GDM, 13.9% living with HIV, and 6.5% without HIV (P = 0.06). Compared with women without GDM, women with GDM had lower median IFN-γ (19.1 versus 141.9 pg/mL, P = 0.03) and interleukin-2 (18.7 versus 249 pg/mL, P < 0.01). Our study suggests that HIV infection is associated with an increased risk of GDM, which is associated with decreased Mycobacterium tuberculosis immune responses. Gestational diabetes screening should be prioriti...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2021
A new tuberculosis diagnostic cartridge assay, which detects a 3-gene tuberculosis signature in w... more A new tuberculosis diagnostic cartridge assay, which detects a 3-gene tuberculosis signature in whole blood, was not diagnostic in women with maternal tuberculosis disease in India (AUC = 0.72). In a cohort of pregnant women, we identified a novel gene set for TB diagnosis (AUC = 0.97) and one for TB progression (AUC = 0.96).
OBJECTIVE There are limited studies on the association of HIV infection with systemic inflammatio... more OBJECTIVE There are limited studies on the association of HIV infection with systemic inflammation during pregnancy. DESIGN A cohort study (N = 220) of pregnant women with HIV (N = 70) (all on antiretroviral therapy) and without HIV (N = 150) were enrolled from an antenatal clinic in Pune, India. METHODS The following systemic inflammatory markers were measured in plasma samples using immunoassays: soluble CD163 (sCD163), soluble CD14 (sCD14), intestinal fatty acid-binding protein (I-FABP), C-reactive protein (CRP), alpha 1-acid glycoprotein (AGP), interferon-β (IFNβ), interferon-γ (IFNγ), interleukin (IL)-1β, IL-6, IL-13, IL-17A and tumor necrosis factor α (TNFα). Generalized estimating equation (GEE) and linear regression models were used to assess the association of HIV status with each inflammatory marker during pregnancy and by trimester, respectively. RESULTS Pregnant women with HIV had higher levels of markers for gut barrier dysfunction (I-FABP), monocyte activation (sCD14) and markers of systemic inflammation (IL-6 and TNFα), but surprisingly lower levels of AGP, an acute phase protein, compared to pregnant women without HIV, with some trimester-specific differences. CONCLUSIONS Our data show that women with HIV had higher levels of markers of gut barrier dysfunction, monocyte activation and systemic inflammation. These markers, some of which are associated with preterm birth, might help explain the increase in adverse birth outcomes in women with HIV and could suggest targets for potential interventions.
Formation of partnerships among young women and men in Pune district, MaharashtraThis report is t... more Formation of partnerships among young women and men in Pune district, MaharashtraThis report is the result of a collaborative study between the KEM Hospital Research Centre (KEMHRC), Pune and the Population Council, New Delhi, with support from the Hewlett and MacArthur Foundations. The survey instrument used in the study is available online at the Population Council website
Aside from their educational attainment economic activity levels and age at marriage little is kn... more Aside from their educational attainment economic activity levels and age at marriage little is known about the lives of young people in India especially the extent to which and the contexts in which they form romantic marital and other partnerships or the nature of these partnerships. At a time when Indias youth policy and reproductive and child health programmes have acknowledged the need to focus on youth it is central that these gaps in understanding are filled. In this context the KEM Hospital Research Centre and the Population Council conducted a study in Maharashtra in 2003-05 to obtain information on romantic and sexual partnership formation and sexual activity among young people (aged 15-24) through a large-scale community-based survey and related textual data gathering. (excerpt)
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