Free Content Human immunodeficiency virus associated tuberculosis more often due to recent infection than reactivation of latent infection [Review article]

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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.

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.

Keywords: HIV; molecular epidemiology; pooled data analysis; systematic review; tuberculosis

Document Type: Review Article

Affiliations: 1: Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK 2: Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK; Karonga Prevention Study, Chilumba, Malawi 3: Karonga Prevention Study, Chilumba, Malawi 4: Research Department of Infection and Population Health, University College London, London, UK 5: Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK 6: Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany 7: Department of Paediatrics, University of Heidelberg, Heidelberg, Germany 8: Biostatistics Unit, Medical Research Council, Cape Town, South Africa 9: School of Medicine, University of Queensland, Brisbane, Queensland, Australia 10: Unit of Infectious Diseases, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden 11: Brigham and Women's Hospital, Boston, Massachusetts, USA; Botswana Harvard School of Public Health AIDS Initiative Partnership, Gaborone, Botswana; Centers for Disease Control and Prevention, Atlanta, Georgia, USA 12: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Publication date: January 1, 2011

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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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