Research ArticleHIV Modeling

Modeling the Dynamic Relationship Between HIV and the Risk of Drug-Resistant Tuberculosis

Science Translational Medicine  23 May 2012:
Vol. 4, Issue 135, pp. 135ra67
DOI: 10.1126/scitranslmed.3003815

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Only Time Will Tell

A picture may be worth a thousand words, but a snapshot only gives you part of the story. Comparing snapshots can help, but inconsistencies may remain. Such is the case for the epidemiological interactions of HIV and tuberculosis (TB). Some researchers have suggested that HIV-infected populations are more susceptible to developing drug-resistant TB. However, different studies of HIV-infected individuals with TB have yielded conflicting results. Now, Sergeev et al. provide a dynamic look at the relationship between HIV infection and the risk of acquiring drug-resistant TB.

The authors developed a mathematical model to explore the effect of HIV on the dynamics of emerging drug-resistant TB. They found that, whereas HIV infection facilitated the rise in numbers of drug-resistant TB infections within a community over several decades, HIV-infected individuals may actually be at lower relative risk of developing drug-resistant TB at the early stages of the coepidemic. Although counterintuitive, these results may be explained by HIV-stimulated reactivation of latent M. Tb infections, acquired at a time when drug-resistant TB was rare. Intriguingly, although HIV infection may increase the prevalence of drug-resistant TB within a population, drug-resistant TB in HIV-seropositive populations may actually be less fit than drug-resistant TB that develops in HIV-seronegative populations—perhaps as a result of less stringent selective pressure. Thus, Sergeev et al. suggest that longitudinal studies, not a snapshot, will provide a better picture of the whole evolving story.