Free Content Risk factors for relapse in human immunodeficiency virus type 1 infected adults with pulmonary tuberculosis

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Abstract:

SETTING: A study conducted by the Uganda-Case Western Reserve University Research Collaboration in Kampala, Uganda, a country with high incidence rates of tuberculosis (TB) and human immunodeficiency virus type 1 (HIV-1) infection.

OBJECTIVE: To assess clinical, microbiologic and radiographic factors associated with risk for relapse in HIV-infected adults treated for initial episodes of pulmonary TB.

DESIGN: Nested case-control study within a randomized prospective clinical trial comparing the safety and efficacy of thiacetazone- and rifampicin-containing regimens for TB treatment in HIV-infected adults.

RESULTS: The analysis was based on 119 patients who completed therapy. Median follow-up for all subjects was 22.3 months. Ten patients relapsed a median of 12.7 months after the end of therapy; seven of these were initially treated with the thiacetazone (T)-containing regimen. Each relapse case was matched to four controls by length of follow-up after initial TB treatment. In a univariate analysis risk for relapse was associated with treatment with the T-containing regimen (OR = 4.2, P = 0.08), age ≥30 yrs (OR = 2.9, P = 0.16), and irregular compliance (OR = 3.6, P = 0.1). Baseline anergy on Mantoux tuberculin skin testing, cavitary disease, radiographic extent of disease and sputum bacillary burden, two month culture negativity, and residual cavitary disease at the end of treatment did not differ between relapses and controls.

CONCLUSION: Older HIV-1 infected patients, those with poor treatment compliance, and those being treated with T-containing regimens, may be at increased risk for relapse after TB treatment and require closer post-treatment surveillance. Risk for relapse in HIV-infected adults with pulmonary TB after treatment with a nine month rifampicin-containing regimen was low (3.1 per 100 person-years observation) compared with those treated with a thiacetazone-containing regimen (10.1 per 100 person-years observation).

Keywords: HIV; relapse; rifampicin; thiacetazone; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda; and National TB and Leprosy Control Programme, Kampala, Uganda 2: Department of Medicine, Division of Infectious Disease, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; and Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda 3: Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda 4: Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda; and Uganda Tuberculosis Investigations Bacteriological Unit, Kampala, Uganda 5: Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda; and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA 6: Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; and Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda

Publication date: October 1, 1997

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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