Impact of HIV infection on the recurrence of tuberculosis in South India.
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.
Narayanan
Sujatha
S
Tuberculosis Research Centre, Indian Council of Medical Research, Chennai 600 031, India. sujatha.sujatha36@gmail.com
Swaminathan
Soumya
S
Supply
Philip
P
Shanmugam
Sivakumar
S
Narendran
Gopalan
G
Hari
Lalitha
L
Ramachandran
Ranjani
R
Locht
Camille
C
Jawahar
Mohideen Shaheed
MS
Narayanan
Paranji Raman
PR
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D015373:Bacterial Typing Techniques / Q000379:methods; D016172:DNA Fingerprinting / Q000379:methods; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D007194:India / Q000453:epidemiology; D008297:Male; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000302:isolation & purification; D012008:Recurrence; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*
D000995:Antitubercular Agents; D004269:DNA, Bacterial