High Rates of Recurrence in HIV‐Infected and HIV‐Uninfected Patients with Tuberculosis

Abstract

Background. The rate of recurrent tuberculosis disease due to reinfection, compared with the incidence of new tuberculosis, in those with and without HIV infection is not known.Methods. In a retrospective cohort study of South African gold miners, men with known dates of seroconversion to HIV (from 1991 to 1997) and HIV-negative men were followed up to 2004. Rates of tuberculosis recurrence 12 years after the first episode were used as a proxy for reinfection disease rates.Results. Among 342 HIV-positive and 321 HIV-negative men who had had у1 previous episode of tuberculosis, rates of recurrence were 19.7 cases per 100 person-years at risk (PYAR; 95% confidence interval [CI], 16.4-23.7) and 7.7 cases per 100 PYAR (95% CI, 6.1-9.8), respectively. The recurrence rate did not vary by duration of HIV infection. Recurrent pulmonary tuberculosis rates 12 years after the first episode were 24.4 cases per 100 PYAR (95% CI, 17.2-34.8) in HIV-positive men and 4.3 cases per 100 PYAR (95% CI, 2.2-8.3) in HIV-negative men, compared with incidence rates of new pulmonary tuberculosis of 3.7 cases per 100 PYAR (95% CI, 3.3-4.1) in HIV-positive men and 0.75 cases per 100 PYAR (95% CI, 0.67-0.84) in HIV-negative men in the same cohort.Conclusions. Tuberculosis recurrence rates, likely due to reinfection, were much higher than incidence rates. The findings suggest heterogeneity in susceptibility, implying that a vaccine could still provide useful protection in the population and strengthening the case for secondary preventive therapy.

Factors Associated With Tb/Hiv Co-Infection Among Drug Sensitive Tuberculosis Patients Managed in a Secondary Health Facility in Lagos, Nigeria

“…TB recurrence depend largely on TB incidence and HIV prevalence (Glynn et al, 2010) and in areas with high TB incidence, previously treated TB patients and those with HIV are at higher risk of developing TB from re-infection than the general population and non-HIV people respectively (Millet et al, 2013;Marx et al, 2012). In this study, TB/HIV co-infected patients were 2 times likely to be retreated cases than TB patients similar to what was reported from San Francisco (Payam et al, 2007).…”

HIV and Tuberculosis: a Deadly Human Syndemic

“…HIV-infected patients appear to be at a higher risk for reinfection with TB, likely because of an impaired capacity to mount long-lasting protective immune responses (115). DNA fingerprinting studies of South African gold miners cured of a first episode of culture-positive TB, who developed recurrent TB, subsequently found that 69% (11 of 14) of culture-positive recurrences in HIV-infected patients were due to reinfection (45).…”

Molecular Epidemiology of HIV-Associated Tuberculosis in Dar es Salaam, Tanzania: Strain Predominance, Clustering, and Polyclonal Disease

“…This suggests that in HIV-infected patients, previous tuberculosis disease does not enhance resistance to subsequent reinfection. In both HIVinfected and HIV-uninfected subjects with a first episode of tuberculosis disease, the risk of a second episode is higher than the risk of a first episode among persons living in the same community (12). In contrast, among patients without HIV infection and in animal models, latent tuberculosis infection has been shown to provide protection against tuberculosis disease upon re-exposure (1,8), likely because an immunologic response that contains a tuberculosis infection also provides resistance to a new exposure.…”