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Free Content Human immunodeficiency virus increases the risk of tuberculosis due to recent re-infection in individuals with latent infection

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BACKGROUND: Human immunodeficiency virus associated tuberculosis (TB) disease can follow reactivation of latent Mycobacterium tuberculosis infection or recent (re-)infection with M. tuberculosis. If contemporary TB cases share identical M. tuberculosis strains (i.e., are ‘clustered’), the episode is likely to have followed recent (re-)infection, irrespective of evidence of previous latent infection.

METHODS: Individuals experiencing a first TB episode between 1996 and 2008 in Karonga District, Northern Malawi, were included if information on M. tuberculosis infection status (from tuberculin tests) before 1990 and a DNA fingerprint from the TB episode were available. We explored differences in proportion clustered by prior M. tuberculosis infection status and HIV status, adjusting for age, sex, bacille Calmette-Guérin scar status and time since tuberculin testing.

RESULTS: Of 79 HIV-negative TB cases, those with previous M. tuberculosis infection were much less likely to be clustered than cases without prior infection (29% vs. 77%, adjusted OR = 0.15, 95%CI 0.04–0.59). Among 119 HIV-positive TB cases, clustering was similar in both groups (88% vs. 84%, adjusted OR = 1.85, 95%CI 0.41–8.29).

DISCUSSION: HIV infection appears to increase the risk of TB following recent re-infection in patients with latent M. tuberculosis infection. Our results add to the mounting evidence that HIV-associated TB mainly follows recent M. tuberculosis infection.
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Keywords: HIV; latent M. tuberculosis infection; molecular epidemiology; re-infection disease; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK; Karonga Prevention Study, Chilumba, Malawi 2: Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK; and Karonga Prevention Study, Chilumba, Malawi 3: Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK 4: Karonga Prevention Study, Chilumba, Malawi

Publication date: 2010-07-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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