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HERO ID
5425781
Reference Type
Journal Article
Title
Impact of HIV infection on the recurrence of tuberculosis in South India
Author(s)
Narayanan, S; Swaminathan, S; Supply, P; Shanmugam, S; Narendran, G; Hari, L; Ramachandran, R; Locht, C; Jawahar, MS; Narayanan, PR
Year
2010
Is Peer Reviewed?
Yes
Journal
Journal of Infectious Diseases
ISSN:
0022-1899
EISSN:
1537-6613
Volume
201
Issue
5
Page Numbers
691-703
Language
English
PMID
20121433
DOI
10.1086/650528
Web of Science Id
WOS:000274296600010
Abstract
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.
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