Contribution of reinfection to recurrent tuberculosis in South African gold miners

Salome Charalambous, A. D. Grant, V. Moloi, R. Warren, J. H. Day, P. Van Helden, R. J. Hayes, K. L. Fielding, K. M. De Cock, R. E. Chaisson, G. J. Churchyard

Research output: Contribution to journalArticle

Abstract

SETTING: A gold mine in South Africa. OBJECTIVE: To investigate incidence and risk factors for tuberculosis (TB) recurrence and the relative contribution of reinfection and relapse to recurrence. DESIGN: Prospective cohort study. METHODS: Employees cured of a first episode of culture-positive TB were followed up for recurrence, which was classified as reinfection or relapse by restriction fragment length polymorphism using an insertion sequence (IS) 6110 probe. RESULTS: Among 609 patients, 57 experienced recurrence during a median follow-up period of 1.02 years, corresponding to a recurrence rate of 7.89 per 100 person-years (py). The culture positive recurrence rate was 5.79/ 100 py, and was higher in human immunodeficiency virus (HIV) infected patients (8.86/100 py in HIV-infected vs. 3.35/100 py in non-HIV-infected). Among HIV-infected patients, the risk of culture-positive recurrence was higher with decreasing CD4 count (compared with CD4 < 200, hazard ratios for recurrence among individuals with CD4 200-500 and CD4 > 500 were 0.40 [95%CI 0.14-1.09] and 0.14 [95%CI 0.02-1.10], respectively, Ptrend = 0.01). IS6110 genotyping was available on both the initial and subsequent isolate for 16/42 (38%, 14 HIV-infected) patients with culture-positive recurrence, and showed reinfection in 11 (69%). CONCLUSION: HIV-infected gold miners, particularly those who are more immunosuppressed, are at higher risk of TB recurrence. TB control strategies need to take into account reinfection as an important cause of recurrent TB.

Original languageEnglish (US)
Pages (from-to)942-948
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume12
Issue number8
StatePublished - Aug 1 2008

Keywords

  • HIV infection
  • RFLP
  • Reinfection
  • South Africa
  • TB recurrence

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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    Charalambous, S., Grant, A. D., Moloi, V., Warren, R., Day, J. H., Van Helden, P., Hayes, R. J., Fielding, K. L., De Cock, K. M., Chaisson, R. E., & Churchyard, G. J. (2008). Contribution of reinfection to recurrent tuberculosis in South African gold miners. International Journal of Tuberculosis and Lung Disease, 12(8), 942-948.