Pasechnik Oksana, Vyazovaya Anna, Vitriv Stanislav, Tatarintseva Marina, Blokh Aleksey, Stasenko Vladimir, Mokrousov Igor
Department of Epidemiology, Omsk State Medical University, Omsk, Russia.
Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, St. Petersburg, Russia.
Tuberculosis (Edinb). 2018 Jan;108:163-168. doi: 10.1016/j.tube.2017.12.003. Epub 2017 Dec 12.
This population-based study characterized Mycobacterium tuberculosis isolates from HIV-positive and HIV-negative tuberculosis (TB) patients in the Omsk region in Western Siberia, Russia. We sought to gain insight into the major genotype families and epidemic and endemic clones of M. tuberculosis in the area with a high burden and adverse trend of TB/HIV coinfection. The study collection included M. tuberculosis isolates from 207 newly-diagnosed patients with pulmonary TB; 55 (26.5%) of patients were HIV-infected. The M. tuberculosis isolates were subjected to drug susceptibility testing and molecular typing based on spoligotyping and analysis of the robust genotype and cluster-specific markers. Patients with disseminated TB disease were more prevalent in the HIV-positive (34.5%) than in the HIV-negative group (4.6%) (P < .001). The Beijing genotype was predominant (62.3% of isolates), and its major subtypes were 94-32-cluster (Central Asian/Russian strain, n = 80) and B0/W148-cluster (successful Russian strain, n = 28). The main non-Beijing families were represented by Latin-American Mediterranean (14.5%), T family (11.1%), Ural (5.8%), and Haarlem (3.9%). Under multivariate logistic regression analysis, MDR was associated with Beijing genotype and not associated with HIV coinfection status (P < .001). Beijing genotype isolates were found more frequently in TB/HIV patients than in TB HIV-negative patients (74.5% versus 57.9%, respectively; P = .031). The non-Beijing genotypes were mainly drug susceptible except for the drug-resistant Ural SIT262 isolates. To summarize, the alarming situation in the Omsk region in Siberia regarding TB/HIV coinfection is seriously influenced by the active circulation of M. tuberculosis isolates of MDR-associated Beijing genotype. Among the non-Beijing families, emergence of the drug-resistant Ural family strains of spoligotype SIT262 warrants attention.
这项基于人群的研究对俄罗斯西西伯利亚鄂木斯克地区 HIV 阳性和 HIV 阴性结核病（TB）患者的结核分枝杆菌分离株进行了特征分析。我们试图深入了解该地区结核病/艾滋病病毒合并感染负担高且呈不良趋势的结核分枝杆菌的主要基因型家族以及流行和地方克隆。研究收集了 207 例新诊断的肺结核患者的结核分枝杆菌分离株；其中 55 例（26.5%）患者感染了 HIV。对结核分枝杆菌分离株进行了药敏试验，并基于间隔寡核苷酸分型以及对强基因型和簇特异性标记的分析进行分子分型。播散性结核病患者在 HIV 阳性组（34.5%）中比在 HIV 阴性组（4.6%）中更为普遍（P <.001）。北京基因型占主导地位（占分离株的 62.3%），其主要亚型为 94 - 32 簇（中亚/俄罗斯菌株，n = 80）和 B0/W148 簇（成功的俄罗斯菌株，n = 28）。主要的非北京家族以拉丁美洲地中海型（14.5%）、T 家族（11.1%）、乌拉尔型（5.8%）和哈勒姆型（3.9%）为代表。在多因素逻辑回归分析中，耐多药与北京基因型相关，与 HIV 合并感染状态无关（P <.001）。在北京基因型分离株中，结核病/艾滋病病毒患者中的发现频率高于结核病 HIV 阴性患者（分别为 74.5%和 57.9%；P = 0.031）。除耐药的乌拉尔 SIT262 分离株外，非北京基因型主要对药物敏感。总之，西伯利亚鄂木斯克地区结核病/艾滋病病毒合并感染的严峻形势受到与耐多药相关的北京基因型结核分枝杆菌分离株活跃传播的严重影响。在非北京家族中， spoligotype SIT262 的耐药乌拉尔家族菌株的出现值得关注。
