Predictive Val. of TB-symptom Screen in HIV-infected & -uninfected Pregnant Women in Pune, India. Substudy: Studying Molecular Mechanisms Leading to Suppressed Immunity in Pregnancy & Studying Relationship between Diet, Gut Microbiome, & Inflammation

Post Date: 
2014-10-28
Clinical Site(s): 
Summary: 
This is a substudy of PRACHITi (PRegnancy And CHanges In Tuberculosis), meaning “wisdom” in Marathi. Pregnancy is a state of relative immunosuppression in order to protect the fetus from being rejected. It has also been shown that the Th-1 helper cell response, which is normally necessary for overcoming TB infection, is suppressed in pregnancy. Thus, pregnant women are especially vulnerable to TB. Active TB during pregnancy has been associated with a six-fold increase in perinatal deaths and a two-fold risk of premature birth and low birth-weight for age.  Understanding the molecular changes in the immune system during pregnancy that increase the risk of active TB during pregnancy is thus important. Human and animal models consistently show that CD4+ T cells and Th1 cytokines are essential in keeping Mycobacterium tuberculosis (MTB) in its latent phase. What we do not understand are the host factors that allow some individuals to progress from latent TB infection (LTBI) to active TB, while others remain asymptomatic for life. The TST is supposed to help identify those at the greatest risk of developing active TB, but it is frequently falsely negative in high-risk populations like those with HIV, the elderly, and pregnant women. We plan to study the expression of these markers during pregnancy and their relationship with the latent TB status of the participants enrolled in the sub-study. This sub-study has been designed as a pilot study and data obtained from this study will be used to design larger studies in the future.
 
Aims and Objectives:
  1. To study the association of diet and gut microbiome with inflammation in HIV-infected and uninfected pregnant women.
  2. To understand the molecular changes in the immune system during pregnancy and their relation to the increased risk of active TB in HIV infected and HIV uninfected pregnant women.

Study ended 2017-09

Collaborators: 
  • BJGMC, Pune, India
  • National Institute for Research in Tuberculosis, Chennai, India
  • National Center for Cell Science, Bangalore, India
  • University College Cork, Cork, Ireland