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Int J Tuberc Lung Dis. 2011 Jan;15(1):24-31.

Human immunodeficiency virus associated tuberculosis more often due to recent infection than reactivation of latent infection.

Author information

  • 1Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK. Rein.Houben@lshtm.ac.uk

Abstract

BACKGROUND:

It is unclear whether human immunodeficiency virus (HIV) increases the risk of tuberculosis (TB) mainly through reactivation or following recent Mycobacterium tuberculosis (re)infection. Within a DNA fingerprint-defined cluster of TB cases, reactivation cases are assumed to be the source of infection for subsequent secondary cases. As HIV-positive TB cases are less likely to be source cases, equal or higher clustering in HIV-positives would suggest that HIV mainly increases the risk of TB following recent infection.

METHODS:

A systematic review was conducted to identify all studies on TB clustering and HIV infection in HIV-endemic populations. Available individual patient data from eligible studies were pooled to analyse the association between clustering and HIV.

RESULTS:

Of seven eligible studies, six contributed individual patient data on 2116 patients. Clustering was as, or more, likely in the HIV-positive population, both overall (summary OR 1.26, 95%CI 1.0-1.5), and within age groups (OR 1.50, 95%CI 0.9-2.3; OR 1.00, 95%CI 0.8-1.3 and OR 2.57, 95%CI 1.4-5.7) for ages 15-25, 26-50 and >50 years, respectively.

CONCLUSIONS:

Our results suggest that HIV infection mainly increases the risk of TB following recent M. tuberculosis transmission, and that TB control measures in HIV-endemic settings should therefore focus on controlling M. tuberculosis transmission rather than treating individuals with latent M. tuberculosis infection.

Comment in

  • Reactivation or re-infection? [Int J Tuberc Lung Dis. 2011]
PMID:
21276292
[PubMed - indexed for MEDLINE]
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