title: Factors affecting tuberculosis strain success over 10 years in a high TB- and HIV-burdened community.
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.
authors.affiliation: 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.
authors.forename: Keren
authors.initials: K
authors.lastname: Middelkoop
authors.affiliation: 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.
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
authors.affiliation: 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.
authors.forename: Barun
authors.initials: B
authors.lastname: Mathema
authors.affiliation: 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.
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
authors.affiliation: 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.
authors.forename: Elena
authors.initials: E
authors.lastname: Shashkina
authors.affiliation: 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.
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.affiliation: 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.
authors.forename: Natalia
authors.initials: N
authors.lastname: Kurepina
authors.affiliation: 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.
authors.forename: Gilla
authors.initials: G
authors.lastname: Kaplan
authors.affiliation: 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.
authors.forename: Barry
authors.initials: B
authors.lastname: Kreiswirth
authors.affiliation: 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.
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D012150:Polymorphism, Restriction Fragment Length; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: Tuberculosis; epidemiology; molecular; polymorphism; pulmonary; restriction fragment length