Eldholm Vegard, Rieux Adrien, Monteserin Johana, Lopez Julia Montana, Palmero Domingo, Lopez Beatriz, Ritacco Viviana, Didelot Xavier, Balloux Francois
Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.
UCL Genetics Institute, University College London, London, United Kingdom.
Elife. 2016 Aug 9;5:e16644. doi: 10.7554/eLife.16644.
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.
结核病（TB）的流行因同时存在的人类免疫缺陷病毒（HIV）流行而加剧，但目前尚不清楚HIV流行在多大程度上推动了结核分枝杆菌（Mtb）的耐药性。在此，我们评估了在南美洲迄今为止最大规模的耐多药结核病疫情中，HIV合并感染对Mtb耐药性出现及传播的影响。通过结合贝叶斯进化分析以及利用针对结核病优化的新模型重建传播网络，我们发现HIV合并感染不会显著影响患者体内Mtb的传播能力或突变率，且与患者体内耐药性增加无关。我们的结果表明，HIV流行通过提供易感宿主库，起到了结核病疫情放大器的作用，但HIV合并感染并非耐药菌株出现及传播的直接驱动因素。
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