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