Contribution of reinfection to recurrent tuberculosis in South African gold miners

Authors: Charalambous, S.¹; Grant, A.D.²; Moloi, V.¹; Warren, R.³; Day, J.H.⁴; van Helden, P.³; Hayes, R.J.²; Fielding, K.L.²; De Cock, K.M.²; Chaisson, R.E.⁵; Churchyard, G.J.⁶

Source: The International Journal of Tuberculosis and Lung Disease, Volume 12, Number 8, August 2008 , pp. 942-948(7)

Publisher: International Union Against Tuberculosis and Lung Disease

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Abstract:

SETTING: A gold mine in South Africa.

OBJECTIVE: To investigate incidence and risk factors for tuberculosis (TB) recurrence and the relative contribution of reinfection and relapse to recurrence.

DESIGN: Prospective cohort study.

METHODS: Employees cured of a first episode of culture-positive TB were followed up for recurrence, which was classified as reinfection or relapse by restriction fragment length polymorphism using an insertion sequence (IS) 6110 probe.

RESULTS: Among 609 patients, 57 experienced recurrence during a median follow-up period of 1.02 years, corresponding to a recurrence rate of 7.89 per 100 person-years (py). The culture positive recurrence rate was 5.79/100 py, and was higher in human immunodeficiency virus (HIV) infected patients (8.86/100 py in HIV-infected vs. 3.35/100 py in non-HIV-infected). Among HIV-infected patients, the risk of culture-positive recurrence was higher with decreasing CD4 count (compared with CD4 < 200, hazard ratios for recurrence among individuals with CD4 200-500 and CD4 > 500 were 0.40 [95%CI 0.14-1.09] and 0.14 [95%CI 0.02-1.10], respectively, P_trend = 0.01). IS6110 genotyping was available on both the initial and subsequent isolate for 16/42 (38%, 14 HIV-infected) patients with culture-positive recurrence, and showed reinfection in 11 (69%).

CONCLUSION: HIV-infected gold miners, particularly those who are more immunosuppressed, are at higher risk of TB recurrence. TB control strategies need to take into account reinfection as an important cause of recurrent TB.

Keywords: RFLP; TB recurrence; reinfection; HIV infection; South Africa

Document Type: Regular paper

Affiliations: 1: Aurum Institute for Health Research, Johannesburg, South Africa 2: London School of Hygiene and Tropical Medicine, London, UK 3: Department of Science and Technology/National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics Facul 4: Aurum Institute for Health Research, Johannesburg, South Africa; and London School of Hygiene and Tropical Medicine, London, UK 5: Johns Hopkins University, Baltimore, Maryland, USA 6: Aurum Institute for Health Research, Johannesburg, South Africa; London School of Hygiene and Tropical Medicine, London, UK; and Centre for AIDS Programme of Research (CAPRISA), University of KwaZulu-Natal, South Africa

Publication date: 2008-08-01

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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.
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Contribution of reinfection to recurrent tuberculosis in South African gold miners

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