When Is the Right Time for Isoniazid Preventive Therapy in Pregnant Women Living with HIV?

Persons living with HIV are at high risk for tuberculosis (TB) reactivation and disease — and TB during pregnancy is associated with adverse maternal and infant outcomes. Based on data in nonpregnant adults, WHO guidelines recommend isoniazid preventive therapy in pregnant women with HIV. In this placebo-controlled, randomized noninferiority trial involving 956 pregnant women (14 through 34 weeks' gestation) with HIV infection, researchers compared the outcomes of isoniazid preventive therapy (300 mg daily for 28 weeks) initiated during pregnancy (immediate group) or at 12 weeks postpartum (deferred group). Participants' median age was 29, 90% were black African, median CD4 count was 493 cells/mm³, all but one were receiving antiretroviral …