title: Impact of HIV co-infection on the evolution and transmission of multidrug-resistant tuberculosis.
abstract: The tuberculosis (TB) epidemic is fueled by a parallel Human Immunodeficiency Virus (HIV) epidemic, but it remains unclear to what extent the HIV epidemic has been a driver for drug resistance in Mycobacterium tuberculosis (Mtb). Here we assess the impact of HIV co-infection on the emergence of resistance and transmission of Mtb in the largest outbreak of multidrug-resistant TB in South America to date. By combining Bayesian evolutionary analyses and the reconstruction of transmission networks utilizing a new model optimized for TB, we find that HIV co-infection does not significantly affect the transmissibility or the mutation rate of Mtb within patients and was not associated with increased emergence of resistance within patients. Our results indicate that the HIV epidemic serves as an amplifier of TB outbreaks by providing a reservoir of susceptible hosts, but that HIV co-infection is not a direct driver for the emergence and transmission of resistant strains.
authors: Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.
authors: Vegard
authors: 0000-0001-6721-3375
authors: V
authors: Eldholm
authors: UCL Genetics Institute, University College London, London, United Kingdom.
authors: Adrien
authors: A
authors: Rieux
authors: Instituto Nacional de Enfermedades Infecciosas, ANLIS Carlos Malbrán, Buenos Aires, Argentina.|Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
authors: Johana
authors: J
authors: Monteserin
authors: UCL Genetics Institute, University College London, London, United Kingdom.
authors: Julia Montana
authors: JM
authors: Lopez
authors: División Tisioneumonología, Hospital Muñiz, Buenos Aires, Argentina.
authors: Domingo
authors: D
authors: Palmero
authors: Instituto Nacional de Enfermedades Infecciosas, ANLIS Carlos Malbrán, Buenos Aires, Argentina.|Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
authors: Beatriz
authors: B
authors: Lopez
authors: Instituto Nacional de Enfermedades Infecciosas, ANLIS Carlos Malbrán, Buenos Aires, Argentina.|Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
authors: Viviana
authors: V
authors: Ritacco
authors: Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
authors: Xavier
authors: 0000-0003-1885-500X
authors: X
authors: Didelot
authors: UCL Genetics Institute, University College London, London, United Kingdom.
authors: Francois
authors: F
authors: Balloux
mesh_terms: D000569:Americas; D000995:Antitubercular Agents / Q000494:pharmacology*; D060085:Coinfection; D018562:Disease Transmission, Infectious; D024901:Drug Resistance, Multiple, Bacterial; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D059645:Mutation Rate; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D013020:South America / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*
chemical_list: D000995:Antitubercular Agents
keywords: HIV; Mycobacterium tuberculosis; antimicrobial resistance; epidemiology; evolution; evolutionary biology; genomics; infectious disease; microbiology; transmission reconstruction