Tuberculosis, human immunodeficiency viruses and TB/HIV co-infection in pregnant women: A meta-analysis

Background: Acquired Immunodeficiency Syndrome (AIDS) and tuberculosis (TB) represent major public health problems. The aim of this systematic review and meta-analysis is the assessment of the prevalence of tuberculosis, human immunodeficiency viruses (HIV), and co-infection of both, in pregnant women. Methods: We searched the literature in PubMed, Scopus, EMBASE, Web of Knowledge and MeSH, from all years of study until 25 April 2018, for articles and abstracts describing tuberculosis, HIV, and co-infection of HIV/TB during the pregnancy. Risk ratio (RRs) and 95% confidence interval (CI) for each outcome were combined, using a random-effects model. Eighteen studies met our inclusion criteria. Results: There was not an association between the incidence risk of tuberculosis during pregnancy in women without any underlying disease. (Risk ratio = 2.43, 95% CI = 0.97-6.08, p = 0.056, I-2 = 88.636, df (Q) = 4, Q-value = 35.198). Pregnancy does not increase the incidence risk of HIV (Risk ratio = 1.27, 95% CI = 1-1.6, p = 0.00, I-2 = 81.024, df (Q) = 17, Q-value = 89.589). The prevalence of HIV has been investigated in three age groups of pregnant women [18-24 years (RR = 1.38), 25-34 years (RR = 1.12), and 35-44 years (RR = 1.71)], but there was not any significant association between the incidence of HIV and the age of the pregnancy. The risk ratio of tuberculosis in HIV positive pregnant women was 2.56 (summary: 95% CI = 1.57-4.17, p = 0.055, I-2 = 56.744, df (Q) = 4, Q-value = 9.247), and pregnancy in HIV positive women increased the incidence risk of tuberculosis. Conclusions: Pregnancy in HIV positive women was associated with an increased tuberculosis risk. Thus, prevention of tuberculosis incidents in these pregnant women would be critical for reducing vertical transmission from mother to child.