High Rates of Recurrent Tuberculosis Disease: A Population-level Cohort Study

Sabine M Hermans, Nesbert Zinyakatira, Judy Caldwell, Frank G J Cobelens, Andrew Boulle, Robin Wood

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.

June 17, 2020
Year of publication
2020
Resource types
Journal and research articles
Countries
Tags
people living with HIV (PLHIV), TB

Similar Resources

This issue of the Southern African HIV Clinicians Society's "HIV Nursing Matters" online magazine focuses on vulnerable populations, including TB in prisons and intimate partner violence in the context of HIV.

This issue of the Southern African HIV Clinicians Society's "HIV Nursing Matters" online magazine focuses on key populations.

According to the World Health Organization, South Africa ranks as one of the highest burden of TB, TB/HIV co-infection, and drug-resistant TB (DR-TB) countries.

The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address…

Background: Chronic respiratory illnesses and respiratory infections are common in HIV-positive populations. It seems reasonable that HIV-positive people experience more respiratory symptoms, such as coughing and breathlessness, than those who are HIV-negative.

Treatment with efavirenz has been associated with rare but severe liver complications among patients receiving antiretroviral therapy (ART) in South Africa.

BACKGROUND:

The goal of virtual elimination of horizontal and mother-to-child HIV transmission in South Africa (SA) has been proposed, but there have been few systematic investigations of which interventions are likely to be most critical to reducing HIV incidence.

Background: A fraction of HIV-diagnosed individuals promptly initiate antiretroviral therapy (ART).