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Anne E. Goldfeld, MD; Julio C. Delgado, MD; Sok Thim; M. Viviana Bozon, MD; Adele M. Uglialoro; David Turbay, MD; Carol Cohen; Edmond J. Yunis, MD

JAMA. 1998;279:226-228.

Context.— Although tuberculosis (TB) is the leading worldwide cause of death due to an infectious disease, the extent to which progressive clinical disease is associated with genetic host factors remains undefined.

Objective.— To determine the distribution of HLA antigens and the frequency of 2 alleles of the tumor necrosis factor (TNF-) gene in unrelated individuals with clinical TB (cases) compared with individuals with no history of clinical TB (controls) in a population with a high prevalence of TB exposure.

Design.— A 2-stage, case-control molecular typing study conducted in 1995-1996.

Setting.— Three district hospitals in Svay Rieng Province in rural Cambodia.

Patients.— A total of 78 patients with clinical TB and 49 controls were included in the first stage and 48 patients with TB and 39 controls from the same area and socioeconomic status were included in the second stage.

Main Outcome Measures.— Presence of HLA class I and class II alleles determined by sequence-specific oligonucleotide probe hybridization and presence of 2 TNF- alleles determined by restriction fragment length polymorphism analysis.

Results.— In the first stage, 7 DQB1*0503 alleles were detected among 156 alleles derived from patients with TB, whereas no DQB1*0503 alleles were found among the 98 alleles derived from controls (P=.04). There was no detectable difference in the distribution of the 2 TNF- alleles in patients with TB compared with controls. In the second stage, we tested for the presence of a single variable, the DQB1*0503 allele, and found 9 DQB1*0503 alleles among 96 alleles derived from patients with TB and no DQB1*0503 alleles among 78 alleles in controls (P=.005).

Conclusions.— The HLA-DQB1*0503 allele is significantly associated with susceptibility to TB in Cambodian patients and, to our knowledge, is the first identified gene associated with development of clinical TB.

From the Divisions of Adult Oncology (Dr Goldfeld and Ms Uglialoro) and Immunogenetics (Drs Delgado, Bozon, Turbay, and Yunis) and the Blood Bank (Ms Cohen), Dana-Farber Cancer Institute, Boston, Mass, and the Cambodian Health Committee, Phnom Penh (Mr Sok).

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