ArticleThe Lancet. Microbe2021
Potential contribution of HIV during first-line tuberculosis treatment to subsequent rifampicin-monoresistant tuberculosis and acquired tuberculosis drug resistance in South Africa: a retrospective molecular epidemiology study.
Article in The Lancet. Microbe, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Association between HIV and acquisition of rifamycin resistance with first-line TB treatment: a systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- Bridging the Gap Between Treatment and Accountability: DR-TB Outcomes and Governance Signals in Rural Eastern Cape, South Africa (2020-2024).Infectious disease reports · 2026Article
- Transmission of rifampicin-resistant tuberculosis in Ho Chi Minh City, Viet Nam: a prospective genomic epidemiology study.The Lancet regional health. Western Pacific · 2026Article
- Article
- Missed PrEP opportunities and vulnerability to HIV during rifampicin-resistant tuberculosis treatment in South Africa.Frontiers in public health · 2026Article
- Epidemiologic and clinical characteristics ofFrontiers in cellular and infection microbiology · 2026Article
- Lymphocyte-Predominant Ascites as a Clue to Peritoneal Tuberculosis: Two Case Reports and a Literature Review.Infection and drug resistance · 2026Article
- Impact of HIV and hospitalization on the incidence of subsequent rifampicin-resistant tuberculosis after initiation of first-line tuberculosis treatment: a retrospective cohort study in South Africa.EClinicalMedicine · 2025Article
- A subunit vaccine Ag85A-LpqH focusing on humoral immunity provides substantial protection against tuberculosis in mice.iScience · 2025Article
- Drug-resistant tuberculosis: a persistent global health concern.Nature reviews. Microbiology · 2024Review
- HIV co-infection is associated with reduced Mycobacterium tuberculosis transmissibility in sub-Saharan Africa.PLoS pathogens · 2024Article
- Surveillance of multidrug-resistant tuberculosis in sub-Saharan Africa through wastewater-based epidemiology.Heliyon · 2023Article
- Effect of compensatory evolution in the emergence and transmission of rifampicin-resistant Mycobacterium tuberculosis in Cape Town, South Africa: a genomic epidemiology study.The Lancet. Microbe · 2023Article
- High mortality among patients hospitalized for drug-resistant tuberculosis with acquired second-line drug resistance and high HIV prevalence.HIV medicine · 2022Article
- Cathelicidins and defensins antimicrobial host defense peptides in the treatment of TB and HIV: Pharmacogenomic and nanomedicine approaches towards improved therapeutic outcomes.Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · 2022Review
- Understanding drivers of phylogenetic clustering and terminal branch lengths distribution in epidemics ofeLife · 2022Article
- Acquired rifampicin resistance during first TB treatment: magnitude, relative importance, risk factors and keys to control in low-income settings.JAC-antimicrobial resistance · 2022Article
- Whole-Genome Sequencing Has the Potential To Improve Treatment for Rifampicin-Resistant Tuberculosis in High-Burden Settings: a Retrospective Cohort Study.Journal of clinical microbiology · 2022Article
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Authors and funding
17 authors at 9 institutions in 5 countries.
Funding
Abstract
backgroundSouth Africa has a high burden of rifampicin-resistant tuberculosis (including multidrug-resistant [MDR] tuberculosis), with increasing rifampicin-monoresistant (RMR) tuberculosis over time. Resistance acquisition during first-line tuberculosis treatment could be a key contributor to this burden, and HIV might increase the risk of acquiring rifampicin resistance. We assessed whether HIV during previous treatment was associated with RMR tuberculosis and resistance acquisition among a retrospective cohort of patients with MDR or rifampicin-resistant tuberculosis.
methodsIn this retrospective cohort study, we included all patients routinely diagnosed with MDR or rifampicin-resistant tuberculosis in Khayelitsha, Cape Town, South Africa, between Jan 1, 2008, and Dec 31, 2017. Patient-level data were obtained from a prospective database, complemented by data on previous tuberculosis treatment and HIV from a provincial health data exchange. Stored MDR or rifampicin-resistant tuberculosis isolates from patients underwent whole-genome sequencing (WGS). WGS data were used to infer resistance acquisition versus transmission, by identifying genomically unique isolates (single nucleotide polymorphism threshold of five). Logistic regression analyses were used to assess factors associated with RMR tuberculosis and genomic uniqueness.
findingsThe cohort included 2041 patients diagnosed with MDR or rifampicin-resistant tuberculosis between Jan 1, 2008, and Dec 31, 2017; of those, 463 (22·7%) with RMR tuberculosis and 1354 (66·3%) with previous tuberculosis treatment. In previously treated patients, HIV positivity during previous tuberculosis treatment versus HIV negativity (adjusted odds ratio [OR] 2·07, 95% CI 1·35-3·18), and three or more previous tuberculosis treatment episodes versus one (1·96, 1·21-3·17) were associated with RMR tuberculosis. WGS data showing MDR or rifampicin-resistant tuberculosis were available for 1169 patients; 360 (30·8%) isolates were identified as unique. In previously treated patients, RMR tuberculosis versus MDR tuberculosis (adjusted OR 4·96, 3·40-7·23), HIV positivity during previous tuberculosis treatment (1·71, 1·03-2·84), and diagnosis in 2013-17 (1·42, 1·02-1·99) versus 2008-12, were associated with uniqueness. In previously treated patients with RMR tuberculosis, HIV positivity during previous treatment (adjusted OR 5·13, 1·61-16·32) was associated with uniqueness as was female sex (2·50 [1·18-5·26]).
interpretationThese data suggest that HIV contributes to rifampicin-resistance acquisition during first-line tuberculosis treatment and that this might be driving increasing RMR tuberculosis over time. Large-scale prospective cohort studies are required to further quantify this risk.
fundingSwiss National Science Foundation, South African National Research Foundation, and Wellcome Trust.
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