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


Houben, RM; Crampin, AC; Ndhlovu, R; Sonnenberg, P; Godfrey-Faussett, P; Haas, WH; Engelmann, G; Lombard, CJ; Wilkinson, D; Bruchfeld, J; Lockman, S; Tappero, J; Glynn, JR; (2011) Human immunodeficiency virus associated tuberculosis more often due to recent infection than reactivation of latent infection. The international journal of tuberculosis and lung disease, 15 (1). pp. 24-31. ISSN 1027-3719

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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.<br/> 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.<br/> 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.<br/> 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.<br/>

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: MEIRU
TB Centre
PubMed ID: 21276292
Web of Science ID: 286488700006
URI: http://researchonline.lshtm.ac.uk/id/eprint/1597

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