Concern at double risk of TB, HIV for pregnant

Women

THE World Health Organization has revealed that 3.3 million women were infected with tuberculosis during 2020 and that women living with HIV are more than likely to contract the disease.

Experts said a study conducted at Cape town hospitals stated that TB among HIV-infected women were over 70% and that only 64% were receiving ART (antiretroviral) drugs despite the availability.

Byron la Hoe of the Western Cape Department of Health referred Weekend Argus to their available statistics of 2019 for the Western Cape Burden of disease, which revealed that HIV prevalence in women is nearly double that in men (13.4% vs 7.3%) and that mother-to-child HIV transmission decreased by nearly 75% in the last 10 years. However, there are still an estimated 600 new cases of mother-to-child transmission each year.

Wendy Kaizer-Philander, MPP DA Western Cape Spokesperson on Health, said in the first half of 2022, 23 000 people were affected and that 9% lost their lives in the same period to the disease.

She said millions of rands had been pumped into TB care at hospitals. “Additionally, this year alone, the department will be spending R388 million on tuberculosis hospitals, which is more than a 5% increase from the previous year.

“Over the medium term, more than R1 billion will be spent on these hospitals. Coupled to this, in the District Health Programmes Grant, the TB component has been allocated R68m this year and almost R208m over the next three years.”

Africa Health said: “People living with conditions that impair the immune system, like HIV, are at a higher risk of developing an active case of TB.

“One study found that HIV-infected women may be twice as likely to contract TB, 1-11% prevalence, compared to 0.06-0.53%.

“The immunological changes associated with pregnancy could render mothers-to-be more vulnerable to either new or latent persisting TB infections.

“One study from 2016 found that TB prevalence among HIV-infected women at a Cape Town hospital sat at over 70% and, despite widespread availability, only 64% of pregnant women with both TB and HIV were using ART drugs.

“Furthermore, among respondents tested in the study, only women with both TB and HIV displayed severe TB manifestations such as TB meningitis, TB pericarditis, abdominal TB and bacteraemia.

“More research is needed to ascertain whether this is primarily because of the immuno-suppression associated with HIV infection, or whether it has more to do with the immunological changes during pregnancy.”

Dr Coceka Mnyani is an expert on tuberculosis and HIV in pregnancy within the African continent and said HIV and TB were a concern for mothers and infants as they could be transmitted from one to the other during pregnancy, childbirth and breastfeeding.

Mnyani echoed the importance of seeking testing if mothers are concerned about symptoms and treatment and reminded pregnant women that the drugs used to treat TB were publicly available and ARTs for HIV, which will not affect safe birthing or breastfeeding and will not negatively impact the foetus or baby in any stage of pregnancy.

Mnyani said education, services, screening, diagnosis, care, treatment and guidelines were key factors. “Studies have suggested a persistently high prevalence of TB among Africa’s pregnant women, TB screening methods may be inadequate, and enhanced TB screening algorithms could improve TB detection, which is crucial for HIV-positive pregnant women.”