Factors affecting tuberculosis strain success over 10 years in a high TB- and HIV-burdened community

Keren Middelkoop; Linda-Gail Bekker; Barun Mathema; Landon Myer; Elena Shashkina; Andrew Whitelaw; Natalia Kurepina; Gilla Kaplan; Barry Kreiswirth; Robin Wood

doi:10.1093/ije/dyu044

Factors affecting tuberculosis strain success over 10 years in a high TB- and HIV-burdened community

Int J Epidemiol. 2014 Aug;43(4):1114-22. doi: 10.1093/ije/dyu044. Epub 2014 Mar 7.

Affiliations

¹ Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, New York, USA, Public Health Research Institute, Tuberculosis Center, New Jersey Medical School, Rutgers, State University of New Jersey, Newark, USA, Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa, National Health Laboratory Service, Cape Town, South Africa, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa and Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USADesmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, New York, USA, Public Health Research Institute, Tuberculosis Center, New Jersey Medical School, Rutgers, State University of New Jersey, Newark, USA, Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa, National Health Laboratory Service, Cape Town, South Africa, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa and Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA keren.middelkoop@hiv-research.org.za.
² Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, New York, USA, Public Health Research Institute, Tuberculosis Center, New Jersey Medical School, Rutgers, State University of New Jersey, Newark, USA, Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa, National Health Laboratory Service, Cape Town, South Africa, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa and Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USADesmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, New York, USA, Public Health Research Institute, Tuberculosis Center, New Jersey Medical School, Rutgers, State University of New Jersey, Newark, USA, Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa, National Health Laboratory Service, Cape Town, South Africa, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa and Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA.
³ Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, New York, USA, Public Health Research Institute, Tuberculosis Center, New Jersey Medical School, Rutgers, State University of New Jersey, Newark, USA, Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa, National Health Laboratory Service, Cape Town, South Africa, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa and Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA.

Abstract

Background: Factors associated with Mycobacterium tuberculosis (Mtb) strain success over time in high burdened communities are unknown.

Methods: Mtb isolates collected over 10 years from sputum-positive tuberculosis (TB) patients resident in the study site underwent IS6110-based restriction fragment length polymorphism analysis. Clinical, demographic and social data were extracted from clinic records and interviewer-administered questionnaires. Strains were defined as persistently successful, transiently successful or unsuccessful based on the average number of cases per year and their continued presence over time.

Results: Genotyping data were available on 789 TB cases. Of the 311 distinct Mtb strains (≥6 bands) identified, 247 were categorized as unsuccessful strains, 12 transiently successful and 10 persistently successful strains. Strain success was not associated with age, gender, antiretroviral use or social factors. Persistently successful strains were less likely to be drug-resistant compared with transiently successful strains [odds ratio (OR): 0.13; 95% confidence interval (CI): 0.04 - 0.5]. Persistently successful strains were positively associated with host HIV-infection compared with unsuccessful strains, but this finding was not robust in sensitivity analyses.

Conclusions: Pathogen characteristics appear to play a greater role in Mtb strain success compared with social or host factors. This study supports the need for further investigations into the role of pathogen characteristics in strain success.

Keywords: Tuberculosis; epidemiology; molecular; polymorphism; pulmonary; restriction fragment length.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Anti-Retroviral Agents / therapeutic use
Child
Child, Preschool
Coinfection
Female
HIV Infections / drug therapy
HIV Infections / epidemiology
Humans
Infant
Male
Middle Aged
Molecular Epidemiology
Mycobacterium tuberculosis / genetics*
Polymorphism, Restriction Fragment Length
South Africa / epidemiology
Tuberculosis, Pulmonary / epidemiology
Tuberculosis, Pulmonary / microbiology*
Young Adult

Substances

Anti-Retroviral Agents

Factors affecting tuberculosis strain success over 10 years in a high TB- and HIV-burdened community

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances

Grants and funding