BACKGROUND: There is limited information on the relative proportion of reactivation and reinfection at the time of recurrence among human immunodeficiency virus (HIV)-infected and HIV-uninfected patients who are successfully treated for tuberculosis infection in India. METHODS: HIV-infected and HIV-uninfected patients with sputum culture-positive pulmonary tuberculosis were treated with short-course regimens and followed up for 36 months at the Tuberculosis Research Centre, South India. Bacteriologic recurrences were documented, and typing of strains was performed using 3 different genotypic techniques: restriction fragment length polymorphism (RFLP) by IS6110, spoligotyping, and mycobacterial interspersed repeat unit (MIRU)-variable number tandem repeat (VNTR). DNA fingerprints of paired Mycobacterium tuberculosis isolates (baseline and recurrence) were compared. RESULTS: Among 44 HIV-infected and 30 HIV-uninfected patients with recurrent tuberculosis during the period July 1999 to October 2005, 25 and 23 paired isolates, respectively, were typed using all 3 methods. Recurrence was due to exogenous reinfection in 88% of HIV-infected and 9% of HIV-uninfected patients (P<.05). Among recurrent isolates, the HIV-infected patients showed more clustering, as well as a higher proportion of drug resistance, including multidrug resistance. CONCLUSIONS: In India, a tuberculosis-endemic country, most recurrences after successful treatment of tuberculosis are due to exogenous reinfection in HIV-infected persons and endogenous reactivation in HIV-uninfected persons. Strategies for prevention and treatment of tuberculosis infection must take these findings into consideration.
BACKGROUND: There is limited information on the relative proportion of reactivation and reinfection at the time of recurrence among human immunodeficiency virus (HIV)-infected and HIV-uninfectedpatients who are successfully treated for tuberculosis infection in India. METHODS:HIV-infected and HIV-uninfectedpatients with sputum culture-positive pulmonary tuberculosis were treated with short-course regimens and followed up for 36 months at the Tuberculosis Research Centre, South India. Bacteriologic recurrences were documented, and typing of strains was performed using 3 different genotypic techniques: restriction fragment length polymorphism (RFLP) by IS6110, spoligotyping, and mycobacterial interspersed repeat unit (MIRU)-variable number tandem repeat (VNTR). DNA fingerprints of paired Mycobacterium tuberculosis isolates (baseline and recurrence) were compared. RESULTS: Among 44 HIV-infected and 30 HIV-uninfectedpatients with recurrent tuberculosis during the period July 1999 to October 2005, 25 and 23 paired isolates, respectively, were typed using all 3 methods. Recurrence was due to exogenous reinfection in 88% of HIV-infected and 9% of HIV-uninfectedpatients (P<.05). Among recurrent isolates, the HIV-infectedpatients showed more clustering, as well as a higher proportion of drug resistance, including multidrug resistance. CONCLUSIONS: In India, a tuberculosis-endemic country, most recurrences after successful treatment of tuberculosis are due to exogenous reinfection in HIV-infectedpersons and endogenous reactivation in HIV-uninfectedpersons. Strategies for prevention and treatment of tuberculosis infection must take these findings into consideration.
Authors: M Gabriela M Gomes; Ricardo Aguas; João S Lopes; Marta C Nunes; Carlota Rebelo; Paula Rodrigues; Claudio J Struchiner Journal: Proc Biol Sci Date: 2012-02-22 Impact factor: 5.349
Authors: A C Pettit; L A Kaltenbach; F Maruri; J Cummins; T R Smith; J V Warkentin; M R Griffin; T R Sterling Journal: Int J Tuberc Lung Dis Date: 2011-07 Impact factor: 2.373
Authors: Nicholas D Walter; Michael Strong; Robert Belknap; Diane J Ordway; Charles L Daley; Edward D Chan Journal: Respirology Date: 2012-07 Impact factor: 6.424
Authors: Timothy R Sterling; Bryan Lau; Jinbing Zhang; Aimee Freeman; Ronald J Bosch; John T Brooks; Steven G Deeks; Audrey French; Stephen Gange; Kelly A Gebo; M John Gill; Michael A Horberg; Lisa P Jacobson; Gregory D Kirk; Mari M Kitahata; Marina B Klein; Jeffrey N Martin; Benigno Rodriguez; Michael J Silverberg; James H Willig; Joseph J Eron; James J Goedert; Robert S Hogg; Amy C Justice; Rosemary G McKaig; Sonia Napravnik; Jennifer Thorne; Richard D Moore Journal: J Infect Dis Date: 2011-09-15 Impact factor: 5.226
Authors: Ted Cohen; Paul D van Helden; Douglas Wilson; Caroline Colijn; Megan M McLaughlin; Ibrahim Abubakar; Robin M Warren Journal: Clin Microbiol Rev Date: 2012-10 Impact factor: 26.132