Objective: To evaluate the safety and effectiveness of isoniazid preventive therapy (IPT) in pregnant women living with HIV (WLWH) through a systematic review and meta-analysis. Introduction: Isoniazid preventive therapy (IPT) is recommended for preventive treatment of tuberculosis in high risk groups. However, evidence on its role in pregnant WLWH remains scarce. Methods: We performed a systematic review and meta-analysis to pool randomized controlled trials (RCTs) as well as non-randomized studies (NRS) where IPT was administered to pregnant WLWH (PROSPERO ID: CRD42024618836). PubMed, Embase, and Cochrane Central databases were searched for relevant articles, until November 15, 2024. Statistical analysis was performed using R Software v4.4.1 and a random-effects model was applied to pool risk ratios (RRs) along with 95% confidence intervals. Results: Five studies with a total of 45,402 patients (mean age = 30 years) were included. The risk of maternal mortality was significantly decreased in pregnant WLWH exposed to IPT compared with the control group (RR 0.42; 95% CI 0.20–0.92; p = 0.03). However, the risks of other outcomes including composite adverse pregnancy outcome (RR 0.90; 95% CI 0.56–1.43; p = 0.66), prematurity (RR 0.86; 95% CI 0.46–1.60; p = 0.63), low birthweight (RR 0.99; 95% CI 0.69–1.42; p = 0.95), very low birthweight (RR 1.28; 95% CI 0.39–4.23; p = 0.55), congenital anomalies (RR 1.48; 95% CI 0.59–3.75; p = 0.41), and hepatotoxicity (RR 0.99; 95% CI 0.71–1.37; p = 0.93) were comparable between the two groups. Conclusion: IPT in pregnant WLWH significantly reduces maternal mortality without increasing adverse pregnancy outcomes. These findings support the continued use of IPT during pregnancy, with careful monitoring for hepatotoxicity, and highlight its potential role as an important maternal health intervention in high TB/HIV burden regions.
Shahid et al. (Sun,) studied this question.