TY - JOUR
T1 - High Rates of Recurrent Tuberculosis Disease
T2 - a population-level cohort study
AU - Hermans, Sabine M.
AU - Zinyakatira, Nesbert
AU - Caldwell, Judy
AU - Cobelens, Frank G. J.
AU - Boulle, Andrew
AU - Wood, Robin
N1 - Funding Information: This work was supported by the European Union (Marie Curie International Outgoing Fellowship for Career Development grant number PIOF-GA-2012-332311; to S. M. H.), the South African Medical Research Council (grant number MRC-RFAUFSP-01-2013/ CCAMP; to R. W.), the National Institutes of Health (grant numbers R01AI058736, R01AI093269; to R. W.), and the Bill & Melinda Gates Foundation (grant number OPP1116641; to R. W.). Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - BACKGROUND: Retreatment tuberculosis (TB) disease is common in high-prevalence settings. The risk of repeated episodes of recurrent TB is unknown. We calculated the rate of recurrent TB per subsequent episode by matching individual treatment episodes over a period of 13 years. METHODS: All recorded TB episodes in Cape Town between 2003 and 2016 were matched by probabilistic linkage of personal identifiers. Among individuals with a first episode notified in Cape Town and who completed their prior treatment successfully we estimated the recurrence rate stratified by subsequent episode and HIV status. We adjusted person-time to background mortality by age, sex, and HIV status. RESULTS: A total of 292 915 TB episodes among 263 848 individuals were included. The rate of recurrent TB was 16.4 per 1000 person-years (95% CI, 16.2-16.6), and increased per subsequent episode (8.4-fold increase, from 14.6 to 122.7 per 1000 from episode 2 to 6, respectively). These increases were similar stratified by HIV status. Rates among HIV positives were higher than among HIV negatives for episodes 2 and 3 (2- and 1.5-fold higher, respectively), and the same thereafter. CONCLUSIONS: TB recurrence rates were high and increased per subsequent episode, independent of HIV status. This suggests that HIV infection is insufficient to explain the high burden of recurrence; it is more likely due to a high annual risk of infection combined with an increased risk of infection or progression to disease associated with a previous TB episode. The very high recurrence rates would justify increased TB surveillance of patients with >1 episode.
AB - BACKGROUND: Retreatment tuberculosis (TB) disease is common in high-prevalence settings. The risk of repeated episodes of recurrent TB is unknown. We calculated the rate of recurrent TB per subsequent episode by matching individual treatment episodes over a period of 13 years. METHODS: All recorded TB episodes in Cape Town between 2003 and 2016 were matched by probabilistic linkage of personal identifiers. Among individuals with a first episode notified in Cape Town and who completed their prior treatment successfully we estimated the recurrence rate stratified by subsequent episode and HIV status. We adjusted person-time to background mortality by age, sex, and HIV status. RESULTS: A total of 292 915 TB episodes among 263 848 individuals were included. The rate of recurrent TB was 16.4 per 1000 person-years (95% CI, 16.2-16.6), and increased per subsequent episode (8.4-fold increase, from 14.6 to 122.7 per 1000 from episode 2 to 6, respectively). These increases were similar stratified by HIV status. Rates among HIV positives were higher than among HIV negatives for episodes 2 and 3 (2- and 1.5-fold higher, respectively), and the same thereafter. CONCLUSIONS: TB recurrence rates were high and increased per subsequent episode, independent of HIV status. This suggests that HIV infection is insufficient to explain the high burden of recurrence; it is more likely due to a high annual risk of infection combined with an increased risk of infection or progression to disease associated with a previous TB episode. The very high recurrence rates would justify increased TB surveillance of patients with >1 episode.
KW - South Africa
KW - antitubercular agents/therapeutic use
KW - epidemiology
KW - incidence
KW - recurrence
UR - http://www.scopus.com/inward/record.url?scp=85107390788&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/cid/ciaa470
DO - https://doi.org/10.1093/cid/ciaa470
M3 - Article
C2 - 32333760
SN - 1058-4838
VL - 72
SP - 1919
EP - 1926
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -