Chronic lung disease and HIV infection are risk factors for recurrent tuberculosis in a low-incidence setting
OBJECTIVES: To determine the TB recurrence rate and to determine if chronic lung disease (CLD) and human immunodeficiency virus (HIV) infection are risk factors for recurrence in this population.
DESIGN: Nested case-control study among TB cases reported to the Tennessee Department of Health between 1 January 2000 and 31 December 2006. Time at risk for recurrence was through 31 December 2007. Multiple imputation accounted for missing data.
RESULTS: Of 1431 TB cases, 20 cases recurred (1.4%, 95%CI 0.9-2.1). Median time at risk for recurrence was 4.5 years (interquartile range 2.7–6.1). Initial and recurrent Mycobacterium tuberculosis isolates were available for genotyping for 15 patients; 12 were consistent with relapse (0.8%, 95%CI 0.4–1.5) and three with re-infection (0.2%, 95%CI 0.04–0.6). HIV infection (OR 5.01, P = 0.04) and CLD (OR 5.28, P = 0.03) were independently associated with recurrent TB, after adjusting for a disease risk score. HIV infection was a risk factor for TB re-infection (P < 0.001).
CONCLUSIONS: In this low-incidence US population, the TB recurrence rate was low, but CLD and HIV were independent risk factors for recurrence. HIV infection was also a risk factor for TB re-infection.
Keywords: human immunodeficiency virus infection; re-infection; recurrence; relapse; tuberculosis
Document Type: Regular Paper
Affiliations: 1: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 2: Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA 3: Tennessee Department of Health, Nashville, Tennessee, USA 4: Department of Preventive Medicine and Center for Education and Research on Therapeutics, Vanderbilt University School of Medicine and the Mid-South Geriatric Research Education and Clinical Center, VA Tennessee Valley Health Care System, Nashville, Tennessee, USA; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 5: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Publication date: 01 July 2011
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