HIV, Pregnancy, and Isoniazid Preventive Therapy. Reply

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The New England Journal of Medicine

Gupta et al. (Oct. 3 issue)1 report a higher incidence of adverse pregnancy outcomes among women with human immunodeficiency virus (HIV) infection who were exposed to isoniazid preventive therapy (IPT) during the second and third trimesters than among those not exposed to IPT during pregnancy. From 2007 through 2015, we conducted a randomized, controlled trial (TEMPRANO ANRS 12136) to evaluate the benefits and risks of 6-month IPT (vs. no IPT) and immediate antiretroviral therapy (ART) (vs. deferred ART) in 2052 West African adults.2,3 During trial follow-up, 85 women became pregnant, including 14 who had voluntary abortions and 2 who died or were lost to follow-up while pregnant. Among the 69 other women, those who received IPT while pregnant were more likely to have adverse pregnancy outcomes than those who did not (15 of 23 women [65%] vs. 25 of 46 [54%]) (Table 1). All the women who received IPT during their pregnancy had exposure to IPT during the first trimester, with a median duration of exposure of 34 days (interquartile range, 26 to 77; range, 10 to 98). Although the between-group difference was not significant in this limited number of women, these findings suggest that the risk of adverse pregnancy outcomes might also increase when IPT is received during the first trimester, not only during the second and third.

Gupta A, Montepiedra G, Theron G. HIV, Pregnancy, and Isoniazid Preventive Therapy. Reply. N Engl J Med. 2020 Mar 19;382(12):1184-1185. doi: 10.1056/NEJMc1916664. PMID: 32187483.