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Older age at first tuberculosis diagnosis is associated with tuberculosis recurrence in HIV-negative persons

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SETTING: Tuberculosis (TB) clinic in Durban, South Africa.

OBJECTIVE: To assess the factors associated with TB recurrence among human immunodeficiency virus (HIV) negative adults and children.

DESIGN: We conducted a retrospective longitudinal study from January 2000 to December 2012. We defined recurrence as a TB episode occurring within the study period after treatment completion or cure of a previous episode. We used a multivariable Poisson regression model to assess the factors associated with the number of recurrences among HIV-negative patients.

RESULTS: Among 17 941 patients with known HIV status, 3653 (20%) were HIV-negative; of these, 235 (6%) had one recurrence, 21 (1%) had two recurrences and 4 (0.1%) had three recurrences. The median follow-up time from the end of treatment for the first episode was 3.0 years (interquartile range 1.9–4.2). Age at the first TB episode was significantly associated with the number of TB recurrences: younger patients had the lowest rate of recurrence, with a steady increase in rates until age 40 years, after which rates stabilized.

CONCLUSIONS: TB recurrence rates among HIV-negative patients were higher at increased age at the first TB episode. Further translational studies are needed to clarify the factors that drive multiple TB recurrences in older age, including impaired immunity, the results of which have implications for TB vaccine development.

Keywords: immunosenescence; reinfection; relapse

Document Type: Research Article

Affiliations: 1: Vanderbilt Tuberculosis Center, Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 2: Vanderbilt Tuberculosis Center, Africa Health Research Institute, Durban 3: Vanderbilt Tuberculosis Center, eThekwini Municipality, Durban, South Africa 4: Vanderbilt Tuberculosis Center, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 5: Vanderbilt Tuberculosis Center, Department of Infectious Diseases, Division of Internal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Publication date: August 1, 2018

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