title: Impact of HIV infection on the recurrence of tuberculosis in South India.
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.
authors.affiliation: Tuberculosis Research Centre, Indian Council of Medical Research, Chennai 600 031, India. sujatha.sujatha36@gmail.com
authors.forename: Sujatha
authors.initials: S
authors.lastname: Narayanan
authors.forename: Soumya
authors.initials: S
authors.lastname: Swaminathan
authors.forename: Philip
authors.initials: P
authors.lastname: Supply
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Shanmugam
authors.forename: Gopalan
authors.initials: G
authors.lastname: Narendran
authors.forename: Lalitha
authors.initials: L
authors.lastname: Hari
authors.forename: Ranjani
authors.initials: R
authors.lastname: Ramachandran
authors.forename: Camille
authors.initials: C
authors.lastname: Locht
authors.forename: Mohideen Shaheed
authors.initials: MS
authors.lastname: Jawahar
authors.forename: Paranji Raman
authors.initials: PR
authors.lastname: Narayanan
mesh_terms: 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*
chemical_list: D000995:Antitubercular Agents; D004269:DNA, Bacterial