New CDC surveillance system.
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Guidelines released by two groups this year recommend resistance testing for all recently infected patients beginning treatment. However, both groups also suggest considering resistance testing for drug-naive patients whose infections are not recent, particularly if the prevalence of resistance in the patient's area is 5% or greater.
Genotyping of Mycobacterium tuberculosis isolates has been widely used to support investigations of outbreaks and as a tool for studying transmission dynamics and other aspects of tuberculosis epidemiology. Its applications to contact investigations are more limited. Targeted typing can be used to confirm or disprove suspected relationships among cases. Universal typing of isolates can be used to identify unsuspected transmission and broaden the scope of contact investigations. In order to properly use the results, one must understand the nature of the changes in the M. tuberculosis genome that produce the heterogeneity reflected in the genotypes, and understand the discriminatory power of the various methods. IS6110 fingerprinting provides the highest discriminatory power, but can be a slow process. Spoligotyping and MIRU-VNTR are PCR-based methods that provide faster turnaround and produce digital results that facilitate comparisons. Appropriately used, isolate genotyping can be a useful adjunct to standard contact investigations.
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Greg Millett, MPH, a behavioral scientist in the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention, discusses the phenomenon and impact on the HIV epidemic of the population of men who have sex with men (MSM) who also have sex with women.
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