Tuberculosis and tuberculosis/HIV co-infection in pregnancy

SummaryBoth tuberculosis (TB) and human immunodeficiency virus (HIV) affect women aged 15–29 years. This is the prime childbearing age group with an increasing mortality due to HIV. The key to the prevention of neonatal TB among these women is early recognition of TB, based primarily on maternal history and relevant investigations of the mother and newborn. There are World Health Organization (WHO) guidelines for maternal prophylaxis and therapy and prophylaxis to the newborn on the stage of the maternal disease. In HIV-infected women, CD4 counts should be monitored urgently as a guide to antiretroviral (ARV) prophylaxis. When the CD4 count is <200 cells/mm3, WHO recommends that the mother should be treated with combination antiretroviral therapy (cART). In resource-rich settings most guidelines recommend treatment with cART when the CD4 count is <350 cells/mm3. The combination of ARVs and anti-TB therapy poses difficulties which can be resolved by combination of different drugs. In both conditions, evidence suggests that in resource-limited settings exclusive breastfeeding is recommended, with the addition of flash heating of the mothers' milk for HIV-infected women.