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Home / The International Journal of Tuberculosis and Lung Disease, Volume 21, Number 11

Open Access Does antiretroviral treatment increase the infectiousness of smear-positive pulmonary tuberculosis?

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BACKGROUND: Understanding of the effects of human immunodeficiency virus (HIV) infection and antiretroviral treatment (ART) on Mycobacterium tuberculosis transmission dynamics remains limited. We undertook a cross-sectional study among household contacts of smear-positive pulmonary tuberculosis (TB) cases to assess the effect of established ART on the infectiousness of TB.

METHOD: Prevalence of tuberculin skin test (TST) positivity was compared between contacts of index cases aged 2–10 years who were HIV-negative, HIV-positive but not on ART, on ART for <1 year and on ART for 1 year. Random-effects logistic regression was used to take into account clustering within households.

RESULTS: Prevalence of M. tuberculosis infection in contacts of HIV-negative patients, HIV-positive patients on ART 1 year and HIV-positive patients not on ART/on ART <1 year index cases was respectively 44%, 21% and 22%. Compared to contacts of HIV-positive index cases not on ART or recently started on ART, the odds of TST positivity was similar in contacts of HIV-positive index cases on ART 1 year (adjusted OR [aOR] 1.0, 95%CI 0.3–3.7). The odds were 2.9 times higher in child contacts of HIV-negative index cases (aOR 2.9, 95%CI 1.0–8.2).

CONCLUSIONS: We found no evidence that established ART increased the infectiousness of smear-positive, HIV-positive index cases.

Keywords: HIV; M. tuberculosis infection; antiretroviral treatment; infectiousness; tuberculosis

Document Type: Research Article

Affiliations: 1: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, Karonga Prevention Study, Chilumba, Malawi 2: Karonga Prevention Study, Chilumba, Malawi 3: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK 4: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, National and Supranational Mycobacterium Reference Laboratory, Forschungszentrum Borstel, Germany

Publication date: 01 November 2017

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