Easterbrook P, Lamprecht D, Ives N, Ferguson A, Makombe R, Lowe O, Mason P, Ndouza A, Mbengeranwa L, Drobniewski F; International Conference on AIDS.

Int Conf AIDS. 2000 Jul 9-14; 13: abstract no. WePeC4436.

P. Easterbrook, Academic Department of HIV/GU Medicine, The Guy's, King's & St Thomas' School of Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RT, United Kingdom, Tel.: +44 20 7848 5770, Fax: +44 20 7848 5769, E-mail: philippa.easterbrook@kcl.ac.uk

Background: Our objective was to examine the pattern of tuberculosis transmission (i.e. reactivation versus recent infection) in Harare, Zimbabwe, using spoligotyping, and the impact of HIV infection. Methods: 502 consecutive adult smear positive pulmonary TB patients presenting to the Beatrice Road TB hospital in Harare between May and October 1997 were enrolled into a prospective cohort study. A detailed epidemiological questionnaire was completed, and HIV and CD4 count testing were performed on each patient. Molecular fingerprinting of genomic DNA recovered from sputum was performed by spoligotyping. Results: The majority (65%) of patients were male, with a median age of 31 years at presentation. 41% gave a history of recent household contact with TB, and 9% had a past history of TB. The overall HIV prevalence was 74%, but this varied significantly according to age: 18-24 yrs 44%; 25-29 yrs 75%; 30-34 yrs 89%; 35-39 yrs 86%; 40-44 yrs 81%; and >45 yrs 66%. DNA suitable for spoligotyping was recovered from 240 patients, and 64 distinct genotypes of MTB were identified. Unique spoligotype patterns were seen in isolates from 40 (16%) patients, and the remaining 207 patient isolates (84%) were contained within 24 clusters (i.e. spoligotype strain shared by > = 2 patients). Cluster size was in general >8 patients, except for 3 large clusters comprising 74, 27 and 25 patient isolates. We found no association between clustering and either age, HIV status, past history of or recent TB contact, and drug resistance. Conclusions: On the basis of the spoligotype pattern, a high proportion of the strains were potentially linked, suggesting active transmission of TB in Harare. Confirmation of these findings using other molecular typing methods is in progress. Ongoing extensive transmission of TB in HIV infected patients has major implications for national TB control programmes.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Adult
• Cluster Analysis
• Cohort Studies
• Demography
• HIV Infections
• HIV Seropositivity
• Humans
• Longitudinal Studies
• Male
• Prevalence
• Prospective Studies
• Sputum
• Tuberculosis
• Tuberculosis, Pulmonary
• Zimbabwe
• transmission

Other ID:

• GWAIDS0003208

UI: 102240702

From Meeting Abstracts