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Tuberculosis Preventive Treatment for Pregnant People With HIV: A Modeling Analysis of Clinical Benefits and Risks

Strategic Insights

— 2 min read

Research conducted by Massachusetts General Hospital and the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network has evaluated the effectiveness of tuberculosis preventive treatment (TPT) for pregnant people with human immunodeficiency virus (HIV) in South Africa. The study used a microsimulation model to compare five TPT strategies among pregnant people with HIV receiving antiretroviral therapy in South Africa. The findings suggest that tuberculosis during pregnancy confers a higher risk of stillbirth and low birth weight, and that immediate TPT can minimize deaths among pregnant people with HIV. However, the study also highlights the uncertainty around the risks of isoniazid, a common TPT regimen, which could outweigh the benefits of tuberculosis deaths averted. As a result, the researchers recommend further studies on newer TPT regimens to inform guidelines.

Key Takeaways:

  • The study evaluated five TPT strategies among pregnant people with HIV receiving antiretroviral therapy in South Africa, including immediate isoniazid (6H) or rifapentine (3HP) treatment during pregnancy or postpartum.
  • Tuberculosis during pregnancy confers a 250% and 81% higher modeled risk of stillbirth and low birth weight, respectively.
  • Immediate TPT can minimize deaths among pregnant people with HIV, with a 38% lower risk of stillbirth and 16% lower risk of low birth weight in lower-risk scenarios.
  • However, immediate TPT can also produce the most combined maternal and fetal/infant deaths in higher-risk scenarios, even with low maternal CD4 cell count and high tuberculosis incidence.
  • The study highlights the need for further research on newer TPT regimens to inform guidelines due to the uncertainty around isoniazid's risks.
  • The research has been peer-reviewed and published in the September 2025 issue of Clinical Infectious Diseases, volume 81, issue 3, pages 613-622.

Statistics:

  • 250%: Higher modeled risk of stillbirth associated with tuberculosis during pregnancy.
  • 81%: Higher modeled risk of low birth weight associated with tuberculosis during pregnancy.
  • 38%: Lower risk of stillbirth in lower-risk scenarios with immediate TPT.
  • 16%: Lower risk of low birth weight in lower-risk scenarios with immediate TPT.
  • 92%: Higher risk of stillbirth in higher-risk scenarios with immediate TPT.
  • 35%: Higher risk of low birth weight in higher-risk scenarios with immediate TPT.

Sources:

  • "Tuberculosis Preventive Treatment for Pregnant People With HIV in South Africa: A Modeling Analysis of Clinical Benefits and Risks." Clinical Infectious Diseases, vol. 81, no. 3, 2025, pp. 613-622.
  • NewsRx. "Reports Outline HIV/AIDS Findings from Massachusetts General Hospital (Tuberculosis Preventive Treatment for Pregnant People With HIV in South Africa: A Modeling Analysis of Clinical Benefits and Risks)." AIDS Weekly, 20 Oct. 2025, p. 143.

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