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. 2015 Jan 1;211(1):53-61.
doi: 10.1093/infdis/jiu403. Epub 2014 Jul 22.

Transmission of tuberculosis in a South African community with a high prevalence of HIV infection

Keren Middelkoop  1 , Barun Mathema  2 , Landon Myer  3 , Elena Shashkina  4 , Andrew Whitelaw  5 , Gilla Kaplan  6 , Barry Kreiswirth  4 , Robin Wood  1 , Linda-Gail Bekker  1
Affiliations

Transmission of tuberculosis in a South African community with a high prevalence of HIV infection

Keren Middelkoop et al. J Infect Dis. .

Abstract

Background: In settings of high tuberculosis transmission, little is known of the interaction between human immunodeficiency virus (HIV) positive and HIV-negative tuberculosis disease and of the impact of antiretroviral treatment (ART) programs on tuberculosis transmission dynamics.

Methods: Mycobacterium tuberculosis isolates were collected from patients with tuberculosis who resided in a South African township with a high burden of tuberculosis and HIV infection. Demographic and clinical data were extracted from clinic records. Isolates underwent IS6110-based restriction fragment length polymorphism analysis. Patients with unique (nonclustered) M. tuberculosis genotypes and cluster index cases (ie, the first tuberculosis case in a cluster) were defined as having tuberculosis due to reactivation of latent M. tuberculosis infection. Secondary cases in clusters were defined as having tuberculosis due to recent M. tuberculosis infection.

Results: Overall, 311 M. tuberculosis genotypes were identified among 718 isolates from 710 patients; 224 (31%) isolates were unique strains, and 478 (67%) occurred in 87 clusters. Cluster index cases were significantly more likely than other tuberculosis cases to be HIV negative. HIV-positive patients were more likely to be secondary cases (P = .001), including patients receiving ART (P = .004). Only 8% of cases of adult-adult transmission of tuberculosis occurred on shared residential plots.

Conclusions: Recent infection accounted for the majority of tuberculosis cases, particularly among HIV-positive patients, including patients receiving ART. HIV-negative patients may be disproportionally responsible for ongoing transmission.

Keywords: HIV; genotyping; molecular epidemiology; transmission; tuberculosis.

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Figures

Figure 1.
Figure 1.
Distribution of unique, index and secondary Mycobacterium tuberculosis isolates, overall and by human immunodeficiency virus status.
Figure 2.
Figure 2.
Couplet strains in the community. Thick red borders (AF140 and CC91) denote both patients with same strain on the same plot. Community orientation has been changed for purposes of confidentiality. Abbreviation: RFLP, restriction fragment length polymorphism.
See this image and copyright information in PMC

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