Authors: Hesseling, A.C.¹; Walzl, G.²; Enarson, D.A.³; Carroll, N.M.²; Duncan, K.⁴; Lukey, P.T.⁵; Lombard, C.⁶; Donald, P.R.¹; Lawrence, K.A.¹; Gie, R.P.¹; van Helden, P.D.²; Beyers, N.¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 14, Number 5, May 2010 , pp. 560-570(11)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

BACKGROUND: Few biomarkers are available to identify tuberculosis (TB) patients at risk of delayed sputum conversion and relapse.

OBJECTIVES: To investigate whether baseline pre-treatment time to detection (TTD) of culture predicted 2-month bacteriological conversion and TB relapse.

METHODS: A total of 263 non-HIV-infected smear-positive previously untreated pulmonary TB patients were prospectively followed from diagnosis until treatment outcome after 6 months' treatment and TB recurrence within 24 months.

RESULTS: The median TTD was 3 days (range 1-17). Of 211 (80.2%) patients with favourable treatment outcome, 22 (10.4%) had recurrence, while 12 (5.7%) had confirmed relapse. Culture conversion at 2 months was associated in univariate analysis with the presence and number of cavities, extensive parenchymal involvement, male sex, sputum smear grading and TTD. In multiple logistic regression, TTD or smear grading and extensive parenchymal involvement both predicted month 2 conversion. Relapse was predicted by TTD, sex, body mass index, smear grading and number of cavities in univariate analysis, and in multivariate regression by TTD and sputum smear grading.

CONCLUSIONS: Baseline TTD and smear grading predicted month 2 culture conversion, relapse and also recurrence. These markers may be useful to identify non-HIV-infected patients at risk of recurrence, and may be relevant in clinical trials.

Keywords: time to detection (TTD); sputum conversion; tuberculosis relapse; recurrence

Document Type: Regular paper

Affiliations: 1: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa 2: Department of Molecular Biology and Human Genetics, Medical Research Council Centre for Molecular and Cellular Biology and the Department of Science and Technology/National Research Foundation Centre of Excellence Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, South Africa 3: International Union Against Tuberculosis and Lung Disease, Paris, France 4: GlaxoSmithKline R&D, Stevenage, UK; and Bill and Melinda Gates Foundation, Seattle, Washington, USA 5: GlaxoSmithKline R&D, Stevenage, UK 6: Biostatistics Unit, Medical Research Council, Tygerberg, South Africa

Publication date: 2010-05-01

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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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