The Impact of Human Immunodeficiency Virus Type 1 on Infectiousness of Tuberculosis: A Meta‐Analysis

Abstract

To assess if the relative infectiousness of patients with tuberculosis is enhanced by coinfection with human immunodeficiency virus type 1 (HIV-1), data from 6 studies of 1240 health care workers who had contact with tuberculosis patients were analyzed. Overall rates of tuberculin skin test conversion were similar regardless of HIV-1 positivity of tuberculosis patients (odds ratio [OR], 1.04; 95% confidence interval [CI], 0.23-1.84). However, when only 3 studies during nosocomial outbreaks of multidrug-resistant Mycobacterium tuberculosis were analyzed, rates of skin test conversion were higher among contacts of HIV-1-positive index cases (OR, 2.85; 95% CI, 1.85-3.85; P=.0002). A second meta-analysis included data from 11 studies of 10,714 household contacts of tuberculosis patients. Prevalence of both skin test positivity (OR, 0.45; 95% CI, 0.20-1.03) and active disease (OR, 1.17; 95% CI, 0.78-1.56) were similar regardless of HIV-1 positivity of index cases. These data suggest that tuberculosis patients with HIV-1 infection are not intrinsically more infectious to their contacts than are HIV-1-negative tuberculosis patients.

HIV and Tuberculosis: a Deadly Human Syndemic

“…A meta-analysis of eight studies comparing the prevalences of TST positivity among household contacts of TB index cases found a lower rate of TST positivity among contacts of HIV-infected than among contacts of HIV-uninfected index TB cases (64). A cross-sectional study evaluating the prevalence of positive TSTs in pediatric contacts of adults with TB and HIV infection in Botswana found a lower proportion of TST positivity in children exposed to adult index cases with CD4 counts of Ͻ200 cells/l than in those exposed to index cases with CD4 counts of Ն200 cells/l (145).…”

Variability of Airborne Transmission of Mycobacterium tuberculosis: Implications for Control of Tuberculosis in the HIV Era

“…Whether HIV-infected patients with tuberculosis are more or less infectious than HIV-uninfected patients with tuberculosis has been debated for years, with studies supporting both more and less transmission from HIV-infected patients, compared with HIV-uninfected patients [14]. Escombe et al [3] suggest that the HIVinfected patients in their cohort were more infectious for tuberculosis than were the HIV-uninfected patients studied by Riley et al [6][7][8]15] during the 1950s.…”

Tuberculosis and Co-infection with the Human Immunodeficiency Virus

“…Similarly, recent work from sub-Saharan Africa has shown that a significant number of new cases of tuberculosis, and recurrent cases of tuberculosis, also result from recent transmission (Sonnenberg et al 2001). Meta-analysis of several studies of health care workers who had contact with tuberculosis patients suggest that patients with tuberculosis co-infected with HIV are not more intrinsically more infectious than are HIV-l negative tuberculosis patients (Cruciani et al 2001). …”