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 <4% or <20% increase in stillbirth or LBW, immediate TPT would produce fewer combined deaths than deferred TPT (sensitivity analysis range, <2%-22% and <11%-120%, respectively). CONCLUSIONS If APO risks are below identifiable thresholds, TPT during pregnancy could decrease combined maternal and fetal/infant deaths. Given uncertainty around isoniazid's risks, and the low threshold at which APO risks could outweigh benefits from tuberculosis deaths averted, studies of newer TPT regimens among PPWH are warranted to inform guidelines.

中文翻译：

---

南非人类免疫缺陷病毒孕妇的结核病预防治疗：临床益处和风险的建模分析。


背景 尽管先前对人类免疫缺陷病毒 （PPWH） 孕妇的结核病预防治疗 （TPT） 的研究报告了相互矛盾的不良妊娠结局 （APO） 风险，但国际指南建议 TPT 用于 PPWH。方法 我们使用微观模拟模型评估了南非接受抗逆转录病毒治疗的 PPWH 的 5 种 TPT 策略： 无 TPT;怀孕期间（即刻 6H 或即刻 3HP）或产后（延迟 6 小时或延迟 3HP）服用 6 个月的异烟肼 （6H） 或 3 个月的异烟肼-利福喷丁 （3HP）。主要结局是孕产妇、胎儿/婴儿和可能受 TPT 影响的原因 （孕产妇结核病、孕产妇肝毒性、死产、低出生体重 [LBW] 和婴儿结核病）导致的合并死亡。妊娠期结核病的死产和 LBW 模型风险分别高出 250% 和 81%。在较低风险或高风险的情况下，立即 TPT 的死产风险降低 38% 或提高 92%，降低 LBW 风险降低 16% 或提高 35%。结果 立即 TPT 将最大限度地减少 PPWH 中的死亡。当 TPT 赋予更高的死产和 LBW 风险时，即使母体 CD4 细胞计数低和结核病发病率高，立即 TPT 也会导致最多的孕产妇和胎儿/婴儿死亡。如果立即 TPT 导致死产或 LBW 增加 <4% 或 <20%，则立即 TPT 产生的合并死亡人数将少于延迟 TPT（敏感性分析范围，分别为 <2%-22% 和 <11%-120%）。结论 如果 APO 风险低于可识别阈值，妊娠期 TPT 可降低孕产妇和胎儿/婴儿合并死亡。 鉴于异烟肼风险的不确定性，以及 APO 风险可能超过避免的结核病死亡获益的低阈值，有必要对 PPWH 中较新的 TPT 方案进行研究，为指南提供信息。