Within-Host Heterogeneity of Mycobacterium Tuberculosis Infection is Associated with Poor Early Treatment Response: a Prospective Cohort Study

Ted Cohen, Leon Chindelevitch, Reshma Misra, Maria E. Kempner, Jerome T Galea, Prashini Moodley, Douglas Wilson

Research output: Contribution to journalArticlepeer-review

Abstract

The clinical management of tuberculosis is a major challenge in southern Africa. The prevalence of within-host genetically heterogeneous Mycobacterium tuberculosis infection and its effect on treatment response are not well understood.We enrolled 500 patients with tuberculosis in KwaZulu-Natal and followed them through 2 months of treatment. Using mycobacterial interspersed repetitive units-variable number of tandem repeats genotyping to identify mycobacterial heterogeneity, we report the prevalence and evaluate the association of heterogeneity with treatment response. Upon initiation of treatment, 21.1% of participants harbored a heterogeneous M. tuberculosis infection; such heterogeneity was independently associated with a nearly 2-fold higher odds of persistent culture positivity after 2 months of treatment (adjusted odds ratio, 1.90; 95% confidence interval, 1.03-3.50).

Original languageAmerican English
JournalJournal of Infectious Diseases
Volume213
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Keywords

  • coinfection
  • HIV/TB
  • mixed infection
  • tuberculosis
  • within-host heterogeneity

Disciplines

  • Social and Behavioral Sciences
  • Social Work

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