The value of end-of-treatment chest radiograph in predicting pulmonary tuberculosis relapse.
METHODS
Patients with cavitary pulmonary tuberculosis (TB) on baseline chest radiograph (CXR) who remain culture-positive after 8 weeks of treatment are at high risk of relapse. The role of end-of-treatment (EOT) CXR in predicting relapse is unclear.


OBJECTIVE
To determine whether EOT CXR independently predicts TB relapse.


METHODS
We conducted a secondary analysis of a randomized trial of intermittent treatment using rifapentine in the continuation phase of TB treatment among 1004 human immunodeficiency virus seronegative adults with culture-proven pulmonary TB.


RESULTS
Relapse occurred in 17.3% of subjects with persistent cavity on EOT CXR, in 7.6% of subjects with a cavity that resolved by EOT, and 2.5% (P=0.002 for trend) of subjects who never had a cavity. In multivariable analysis, patients with persistent cavity on EOT CXR were significantly more likely to relapse than patients with no cavity on baseline or 2-month CXR (hazard ratio [HR] 4.22, 95%CI 2.00-8.91), and were more likely to relapse than subjects whose early cavity had resolved by EOT CXR (HR 1.92, 95%CI 1.09-3.39).


CONCLUSIONS
A persistent cavity after 6 months of TB treatment was independently associated with disease relapse after controlling for other variables. EOT CXR may help predict those likely to relapse.
Hamilton
C D
CD
Division of Infectious Diseases & International Health, Duke University Medical Center, Durham, North Carolina 27710, USA. dukes002@mc.duke.edu
Stout
J E
JE
Goodman
P C
PC
Mosher
A
A
Menzies
R
R
Schluger
N W
NW
Khan
A
A
Johnson
J L
JL
Vernon
A N
AN
D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D008400:Mass Chest X-Ray / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012293:Rifampin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology
D000904:Antibiotics, Antitubercular; D012293:Rifampin; C018421:rifapentine