HIV co-infection is associated with reduced Mycobacterium tuberculosis transmissibility in sub-Saharan Africa

• DOI: 10.1371/journal.ppat.1011675
• Publication Date: 2024-05-02T17:48:04Z
• Authors: Etthel M. Windels; Eddie M. Wampande; Moses L. Joloba; W. Henry Boom; Galo A. Goig; Helen Cox; Jerry Hella; Sonia Borrell; Sebastien Gagneux; Daniela Brites; Tanja Stadler
• Keywords: Male; Adult; Transmissibility (structural dynamics); QH301-705.5; Epidemiology; Immunology; HIV Infections; FOS: Health sciences; Microbiology; Quantum mechanics; Vibration; Diagnosis, Treatment, and Epidemiology of Nontuberculous Mycobacterial Diseases; Diagnosis and Management of Abdominal Tuberculosis; Risk Factors; Virology; Health Sciences; Pathology; Humans; Tuberculosis; Vibration isolation; Biology (General); Biology; Africa South of the Sahara; Coinfection; FOS: Clinical medicine; Physics; Bayes Theorem; Human immunodeficiency virus (HIV); Mycobacterium tuberculosis; RC581-607; CD4 Lymphocyte Count; Infectious Diseases; FOS: Biological sciences; Medicine; Female; Surgery; Immunologic diseases. Allergy; Research Article

Persons living with HIV are known to be at increased risk of developing tuberculosis (TB) disease upon infection with Mycobacterium tuberculosis (Mtb). However, it has remained unclear how HIV co-infection affects subsequent Mtb transmission from these patients. Here, we customized a Bayesian phylodynamic framework to estimate the effects of HIV co-infection on the Mtb transmission dynamics from sequence data. We applied our model to four Mtb genomic datasets collected in sub-Saharan African countries with a generalized HIV epidemic. Our results confirm that HIV co-infection is a strong risk factor for developing active TB. Additionally, we demonstrate that HIV co-infection is associated with a reduced effective reproductive number for TB. Stratifying the population by CD4+ T-cell count yielded similar results, suggesting that, in this context, CD4+ T-cell count is not a better predictor of Mtb transmissibility than HIV infection status alone. Together, our genome-based analyses complement observational household contact studies, and more firmly establish the negative association between HIV co-infection and Mtb transmissibility.