Recurrent tuberculosis and its risk factors: Adequately treated patients are still at high risk

G. W. Comstock, J. E. Golub, Rajesh Panjabi

Research output: Contribution to journalReview articlepeer-review

95 Scopus citations


Recurrent tuberculosis (TB) poses significant threats, including drug resistance, to TB control programs. However, recurrence and its causes, particularly in the era of epidemic human immunodeficiency virus (HIV), have not been well described. We systematically searched published material for studies reporting on recurrent TB following completion of standard treatment regimens to provide data on the issue. A total of 32 studies were reviewed. Among controlled trials, the overall recurrence rates (per 100 000 person-years) were respectively 3010 (95%CI 2230-3970) and 2290 (95%CI 1730-2940) at 6 and 12 months after treatment completion. Recurrence rates were higher among observational studies compared to controlled trials and in countries with high versus low background TB incidence. TB recurrence (%) was higher among HIV-infected (6.7, 95%CI 5.9-7.6) than non-HIV-infected individuals (3.3, 95%CI 2.8-3.9). Factors independently associated with recurrence in the literature included residual cavitation, greater area of involved lung tissue, positive sputum culture at 2 months of treatment and HIV infection. Among those with HIV infection, recurrent TB was associated with a low initial CD4 count and receiving less than 37 weeks of antituberculosis treatment. We argue that adequately treated patients are still at high risk for recurrent disease and should be considered in case-finding strategies. Moreover, those with multiple risk factors may benefit from modification of standard treatment.

Original languageEnglish (US)
Pages (from-to)828-837
Number of pages10
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number8
StatePublished - Aug 2007


  • Pulmonary tuberculosis
  • Recurrence
  • Risk factors

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases


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