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Free Content The impact of HIV infection on recurrence of tuberculosis in South African gold miners

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DESIGN AND OBJECTIVES: Potential risk factors for recurrence of tuberculosis (TB) were investigated in a retrospective cohort study of 305 human immunodeficiency virus (HIV) positive and 984 HIV-negative South African gold miners treated for TB with directly-observed, rifampicin-based regimens. Standard treatment changed from rifampicin, isoniazid and pyrazinamide (RHZ) to RHZ plus ethambutol (RHZE) during the study period.

RESULTS: Recurrence occurred in 37 HIV-positive and 46 HIV-negative men. HIV infection was associated with a significantly higher recurrence rate (8.2 vs 2.2 per 100 person-years; multivariate-adjusted incidence rate ratio [IRR] 4.9, 95% confidence interval [CI] 3.0–8.1), as were post-tuberculous scarring (multivariate-adjusted IRR 1.6 for one or two scarred lung zones, 4.0 for three or more zones; test for trend P < 0.001) and drug resistance (multivariate-adjusted IRR 2.7, 95%CI 1.01–7.4). The recurrence rate was significantly higher following treatment with RHZ than RHZE (multivariate-adjusted IRR 2.1, 95%CI 1.1–4.0). The difference between regimens needs to be interpreted with caution, however, as allocation was not randomised.

CONCLUSION: The high recurrence rate among HIV-positive men requires further investigation to distinguish relapse from re-infection as the predominant cause, leading to consideration of further intensification of the initial regimen or use of secondary prophylaxis.

Keywords: HIV infection; recurrent tuberculosis

Document Type: Regular Paper

Affiliations: 1: Aurum Health Research, Welkom, South Africa 2: Medical Research Council, Durban, South Africa 3: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

Publication date: May 1, 2000

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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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