Recurrent tuberculosis in HIV-infected patients in Rio de Janeiro, Brazil.
OBJECTIVE
The risk of recurrent tuberculosis may increase in HIV-infected patients due to exogenous reinfection. We measured the frequency of and determined risk factors for recurrent tuberculosis in a cohort of HIV-infected patients in Rio de Janeiro, Brazil.


METHODS
Data were abstracted from medical records of HIV-infected patients attending 29 HIV clinics between 1998 and 2007. Patients analyzed were those who had no tuberculosis history prior to their first HIV clinic visit and who had at least one episode of tuberculosis after entry. Incidence rate ratios compared incidence rates between risk groups and Cox proportional hazards regression models evaluated unadjusted and adjusted associations.


RESULTS
Among 1080 HIV-infected patients with tuberculosis, 96 (8.9%) developed a recurrent diagnosis. The median time between diagnoses was 2.4 years. Fewer patients with recurrent tuberculosis had completed their initial 6-month course of tuberculosis treatment compared with patients without recurrence (78 versus 86%; P = 0.02). For patients who completed therapy, the incidence rate of recurrence was 2.5/100 versus 9.0/100 person-years for noncompleters (incidence rate ratio, 3.60; 95% confidence interval, 1.92-6.32). In multivariate modeling, initial tuberculosis treatment completion, receipt of antiretroviral therapy, and CD4 cell count more than 200 mm any time after the initial diagnosis were associated with a significantly decreased hazard of recurrence.


CONCLUSIONS
Tuberculosis recurrence rates were high in this HIV-infected population. Completion of initial tuberculosis therapy, use of antiretroviral therapy, and increases in CD4 cell counts were associated with lower recurrence rates. Use of secondary preventive therapy might be warranted to reduce the burden of tuberculosis in patients with HIV infection.
Golub
Jonathan E
JE
Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231, USA. jgolub@jhmi.edu
Durovni
Betina
B
King
Bonnie S
BS
Cavalacante
Solange C
SC
Pacheco
Antonio G
AG
Moulton
Lawrence H
LH
Moore
Richard D
RD
Chaisson
Richard E
RE
Saraceni
Valeria
V
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral; D012307:Risk Factors; D055502:Secondary Prevention; D014374:Tuberculin Test / Q000592:standards; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D019562:Viral Load
D044966:Anti-Retroviral Agents; D012367:RNA, Viral