The impact of HIV infection on tuberculosis transmission in a country with low tuberculosis incidence: a national retrospective study using molecular epidemiology.
The impact of HIV infection on tuberculosis transmission in a country with low tuberculosis incidence: a national retrospective study using molecular epidemiology.
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DOI：
10.1186/s12916-020-01849-7
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发表时间：
2020-12-14
期刊：
影响因子：
9.3
通讯作者：
Stagg HR
中科院分区：
文献类型：
--
作者：
Winter JR;Smith CJ;Davidson JA;Lalor MK;Delpech V;Abubakar I;Stagg HR
众所周知，艾滋病毒会增加潜伏性结核病重新激活为活动性结核病的可能性；然而，其对结核病传染性和随后传播的影响尚不清楚，特别是在低发病率环境中。回顾性地使用英格兰、威尔士和北爱尔兰 2010 年至 2014 年成人结核病病例的国家监测数据，使用 24 位分枝杆菌散布重复单元可变数量串联重复进行菌株分型来回顾性识别结核病病例群，并将其细分为“首例”和“后续”病例。首先，我们使用零膨胀泊松回归模型来检查 HIV 状态与菌株类型簇中后续簇状病例数（结核病传染性的替代）之间的关联。其次，我们使用逻辑回归来检查 HIV 状态与成为聚集性病例（最近获得结核感染的替代物）中的后续病例（最近获得结核感染的替代物）的可能性与首例病例或非聚集性病例（潜伏感染重新激活的替代物）相比之间的关联。我们纳入了 18,864 株毒株型病例，其中 2238 例为聚集性病例，8471 例为后续病例。七百五十九 (4%) 人艾滋病毒呈阳性。结果 1：簇中首个 HIV 阳性肺结核病例的后续病例数（平均值 0.6，多变量发病率比 [IRR] 0.75 [0.65–0.86]）少于 HIV 阴性病例（平均值 1.1）。与 HIV 阴性 EPTB 病例相比，感染 HIV 的肺外结核 (EPTB) 病例不太可能成为聚集性病例中的首例。首例 EPTB 病例的后续病例平均数（平均 2.5，IRR（3.62 [3.12–4.19]）高于 HIV 阴性患者（平均 0.6）。结果 2：与首例或后续病例相比，HIV 合并感染的结核病病例不太可能成为集群中的后续病例（比值比 0.82 [0.69–0.98]）。结果 1：肺结核 HIV 患者的传染性低于未感染 HIV 的患者，作为聚集性病例中的首个病例，其后续病例的数量较多，因此可能是通过接触调查发现的其他未发现病例的标志。 结果 2：与 HIV 阴性患者相比，HIV 阳性患者中的结核病更有可能是由新感染引起的。 10.1186/s12916-020-01849-7。
HIV is known to increase the likelihood of reactivation of latent tuberculosis to active TB disease; however, its impact on tuberculosis infectiousness and consequent transmission is unclear, particularly in low-incidence settings. National surveillance data from England, Wales and Northern Ireland on tuberculosis cases in adults from 2010 to 2014, strain typed using 24-locus mycobacterial-interspersed-repetitive-units–variable-number-tandem-repeats was used retrospectively to identify clusters of tuberculosis cases, subdivided into ‘first’ and ‘subsequent’ cases. Firstly, we used zero-inflated Poisson regression models to examine the association between HIV status and the number of subsequent clustered cases (a surrogate for tuberculosis infectiousness) in a strain type cluster. Secondly, we used logistic regression to examine the association between HIV status and the likelihood of being a subsequent case in a cluster (a surrogate for recent acquisition of tuberculosis infection) compared to the first case or a non-clustered case (a surrogate for reactivation of latent infection). We included 18,864 strain-typed cases, 2238 were the first cases of clusters and 8471 were subsequent cases. Seven hundred and fifty-nine (4%) were HIV-positive. Outcome 1: HIV-positive pulmonary tuberculosis cases who were the first in a cluster had fewer subsequent cases associated with them (mean 0.6, multivariable incidence rate ratio [IRR] 0.75 [0.65–0.86]) than those HIV-negative (mean 1.1). Extra-pulmonary tuberculosis (EPTB) cases with HIV were less likely to be the first case in a cluster compared to HIV-negative EPTB cases. EPTB cases who were the first case had a higher mean number of subsequent cases (mean 2.5, IRR (3.62 [3.12–4.19]) than those HIV-negative (mean 0.6). Outcome 2: tuberculosis cases with HIV co-infection were less likely to be a subsequent case in a cluster (odds ratio 0.82 [0.69–0.98]), compared to being the first or a non-clustered case. Outcome 1: pulmonary tuberculosis-HIV patients were less infectious than those without HIV. EPTB patients with HIV who were the first case in a cluster had a higher number of subsequent cases and thus may be markers of other undetected cases, discoverable by contact investigations. Outcome 2: tuberculosis in HIV-positive individuals was more likely due to reactivation than recent infection, compared to those who were HIV-negative. The online version contains supplementary material available at 10.1186/s12916-020-01849-7.
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影响因子：
3.7
作者：
Aldridge RW;Shaji K;Hayward AC;Abubakar I
通讯作者：
Abubakar I
DOI：
10.1164/rccm.200708-1256oc
发表时间：
2008-07-01
影响因子：
24.7
作者：
Kik, Sandra V.;Verver, Suzanne;Borgdorff, Martien W.
通讯作者：
Borgdorff, Martien W.
影响因子：
5
作者：
Davidson, Jennifer A.;Thomas, H. Lucy;Lalor, Maeve K.
通讯作者：
Lalor, Maeve K.
影响因子：
7.7
作者：
Guerra-Assunção JA;Crampin AC;Houben RM;Mzembe T;Mallard K;Coll F;Khan P;Banda L;Chiwaya A;Pereira RP;McNerney R;Fine PE;Parkhill J;Clark TG;Glynn JR
通讯作者：
Glynn JR
DOI：
10.1164/rccm.200405-590oc
发表时间：
2004-09-15
影响因子：
24.7
作者：
Corbett, EL;Charalambous, S;Churchyard, GJ
通讯作者：
Churchyard, GJ