Format

Send to

Choose Destination
See comment in PubMed Commons below
J Infect Dis. 2015 Jan 1;211(1):53-61. doi: 10.1093/infdis/jiu403. Epub 2014 Jul 22.

Transmission of tuberculosis in a South African community with a high prevalence of HIV infection.

Author information

1
Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine Department of Medicine.
2
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York Public Health Research Institute Tuberculosis Center.
3
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town.
4
Public Health Research Institute Tuberculosis Center.
5
Division of Medical Microbiology, University of Stellenbosch National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa.
6
Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School-Rutgers, The State University of New Jersey, Newark.

Abstract

BACKGROUND:

In settings of high tuberculosis transmission, little is known of the interaction between human immunodeficiency virus (HIV) positive and HIV-negative tuberculosis disease and of the impact of antiretroviral treatment (ART) programs on tuberculosis transmission dynamics.

METHODS:

Mycobacterium tuberculosis isolates were collected from patients with tuberculosis who resided in a South African township with a high burden of tuberculosis and HIV infection. Demographic and clinical data were extracted from clinic records. Isolates underwent IS6110-based restriction fragment length polymorphism analysis. Patients with unique (nonclustered) M. tuberculosis genotypes and cluster index cases (ie, the first tuberculosis case in a cluster) were defined as having tuberculosis due to reactivation of latent M. tuberculosis infection. Secondary cases in clusters were defined as having tuberculosis due to recent M. tuberculosis infection.

RESULTS:

Overall, 311 M. tuberculosis genotypes were identified among 718 isolates from 710 patients; 224 (31%) isolates were unique strains, and 478 (67%) occurred in 87 clusters. Cluster index cases were significantly more likely than other tuberculosis cases to be HIV negative. HIV-positive patients were more likely to be secondary cases (P = .001), including patients receiving ART (P = .004). Only 8% of cases of adult-adult transmission of tuberculosis occurred on shared residential plots.

CONCLUSIONS:

Recent infection accounted for the majority of tuberculosis cases, particularly among HIV-positive patients, including patients receiving ART. HIV-negative patients may be disproportionally responsible for ongoing transmission.

KEYWORDS:

HIV; genotyping; molecular epidemiology; transmission; tuberculosis

PMID:
25053739
PMCID:
PMC4334823
DOI:
10.1093/infdis/jiu403
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems Icon for PubMed Central
    Loading ...
    Support Center