HIV-1 and recurrence, relapse, and reinfection of tuberculosis after cure: a cohort study in South African mineworkers
HIV-1 and recurrence, relapse, and reinfection of tuberculosis after cure: a cohort study in South African mineworkers
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DOI：
10.1016/s0140-6736(01)06712-5
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发表时间：
2001-11-17
期刊：
影响因子：
168.9
通讯作者：
Godfrey-Faussett, P
中科院分区：
文献类型：
--
作者：
Sonnenberg, P;Murray, J;Godfrey-Faussett, P
背景由于复发或再感染导致的结核病复发病例的比例以及与这些不同机制相关的危险因素尚不清楚。我们随访了一组326名南非矿工，他们在1995年成功地完成了肺结核的治疗，以确定复发率和机制。方法于治愈后3个月和6个月对患者进行检查，并于1998年12月前进行常规结核病监测。研究人员比较了首次和随后结核发作的IS6110 DNA指纹，以确定复发是由于复发还是再感染。所有患者都同意进行HIV-1检测。在随访期间（中位25.1个月，IQR为13.2-33.4），65例患者（20%）出现结核病复发，复发率为每100人-年（PYAR） 10.3次，hiv -1阳性患者为16.0次，hiv -1阴性患者为6.4次。65例复发患者中有39例可获得配对DNA指纹图谱：25对相同（复发），14对不同（再感染）。93%（13/14）的前6个月复发可归因于复发，而48%（12/25）的后6个月复发可归因于复发。HIV-1感染是复发的危险因素（危险比2.4,95% CI 1.5-4.0），因为它与再感染引起的疾病有很强的相关性（18.7 2.4-143），但与复发无关（0.58;0.24-1.4）。残留空化和在矿工作年限的增加是复发的危险因素。在结核病感染高风险的环境中，HIV-1增加了结核病复发的风险，因为再感染的风险增加。预防疾病复发的干预措施，如hiv -1阳性结核病患者的终身化学预防，应进一步评估。
Background The proportion of recurrent tuberculosis cases attributable to relapse or reinfection and the risk factors associated with these different mechanisms are poorly understood. We followed up a cohort of 326 South African mineworkers, who had successfully completed treatment for pulmonary tuberculosis in 1995, to determine the rate and mechanisms of recurrence.Methods Patients were examined 3 and 6 months after cure, and then were monitored by the routine tuberculosis surveillance system until December, 1998. IS6110 DNA fingerprints from initial and subsequent episodes of tuberculosis were compared to determine whether recurrence was due to relapse or reinfection All patients gave consent for HIV-1 testing.Findings During follow-up (median 25.1 months, IQR 13.2-33.4), 65 patients (20%) had a recurrent episode of tuberculosis, a recurrence rate of 10.3 episodes per 100 person-years at risk (PYAR)-16.0 per 100 PYAR in HIV-1-positive patients and 6.4 per 100 PYAR in HIV-1-negative patients. Paired DNA fingerprints were available in 39 of 65 recurrences: 25 pairs were identical (relapse) and 14 were different (reinfection). 93% (13/14) of recurrences within the first 6 months were attributable to relapse compared with 48% (12/25) of later recurrences. HIV-1 infection was a risk factor for recurrence (hazard ratio 2.4, 95% CI 1.5-4.0), due to its strong association with disease caused by reinfection (18.7 2.4-143), but not relapse (0.58; 0.24-1.4). Residual cavitation and increasing years of employment at the mine were risk factors for relapse.Interpretation In a setting with a high risk of tuberculous Infection, HIV-1 increases the risk of recurrent tuberculosis because of an Increased risk of reinfection. Interventions to prevent recurrent disease, such as lifelong chemoprophylaxis in HIV-1-positive tuberculosis patients, should be further assessed.