995.  Transmission of HIV and non-HIV TB cases in Mississippi: Intensified Efforts are needed among African Americans and HIV-infected sub-populations
Session: Poster Abstract Session: Clinical Studies of Tuberculosis
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IDSA 2011_final.pdf (397.0 kB)
  • Background: HIV infection increases the risk of tuberculosis (TB) reactivation. Previously, we found that HIV, African American race and homelessness were  risk factors for recently transmitted TB disease in one urban county.  With molecular epidemiology we investigate TB among HIV seropositive (HIV +) and negative (HIV -) individuals in the state.

    Methods: This retrospective cohort study analyzed clinical and molecular strain data from the Mississippi State Department of Health and CDC respectively.  Culture positive pulmonary TB cases, 2004-2010 were reviewed.   Chi-squared or fisher exact analysis were used to describe categorical variables and t-test for continuous variables.

    Results: There were 595 culture positive cases from 2004-2010; 72% were males, 65% African Americans (AA), and 7% Hispanic; 13% were homeless with 21%alcohol and 12% non IV drug usage. HIV testing was available for 95%.  There were 59(10%) HIV + of which 48/59(81%) were males, 47/52(90%) AA, 23/59(39%) homeless, 12/59(20%) and 19/59(32%) admitted to alcohol or non-IV drug usage, 32/59 lived in one county. HIV + were significantly younger (45.1 years ±8.8) than HIV - (51.5 years ± 19) (P=0.01). HIV + were more likely to be AA, non-homeless (p<0.001) and have non-cavitary chest x-ray findings (P<0.005); There were 90 Mycobacterium tuberculosis strains; 58 occurred in TB clusters, and 89% were of EuroAmerican Lineage. The dominant clusters in both HIV+ and HIV - were MS0006 and MS0003 respectively.  In a sub-analysis of MS0006 strain, AA were more likely to be HIV + (p=0.04)); no statistical difference was noted in other key demographic and clinical characteristics.

    Conclusion:  There was a high degree of clustering within the state and HIV+ persons with the majority belonging to the MS0006 and MS0003 strains.  HIV + were younger and non-homeless. African American race was a risk factor for HIV/TB co-infection (P<0.001) and belonging to the MS0006 TB cluster (p=0.004).  Measures to interrupt TB transmission in African Americans and HIV co-infected populations are necessary to accelerate TB elimination.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Brian Temple, MD1,2, Imran Sunesara, MBBS, MPH3, Awewura Kwara, MD4, Thomas Dobbs, M.D., M.P.H.5, Mike Holcomb, MPH6 and Risa Webb, MD, DTMH3,7,8, (1)Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI, (2)Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, (3)University of Mississippi Medical Center, Jackson, MS, (4)Infectious DIsease, Brown Medical School, Providence, RI, (5)Mississippi State Department of Health, Hattisburg, MS, (6)TB and Refugee Health, Mississippi State Department of Health, Jackson, MS, (7)MS State Dept of Health, Jackson, MS, (8)G.V. "Sonny" Montgomery VA Medical Center, Jackson, MS

    Disclosures:

    B. Temple, None

    I. Sunesara, None

    A. Kwara, None

    T. Dobbs, None

    M. Holcomb, None

    R. Webb, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.