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

Rein M G J Houben, A. C. Crampin, R. Ndhlovu, P. Sonnenberg, P. Godfrey-Faussett, W. H. Haas, G. Engelmann, C. J. Lombard, D. Wilkinson, J. Bruchfeld, S. Lockman, J. Tappero, J. R. Glynn

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43 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)24-31
Number of pages8
JournalInternational Journal of Tuberculosis and Lung Disease
Volume15
Issue number1
Publication statusPublished - Jan 2011
Externally publishedYes

Keywords

  • HIV
  • Molecular epidemiology
  • Pooled data analysis
  • Systematic review
  • Tuberculosis

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