title: High rates of recurrence in HIV-infected and HIV-uninfected patients with tuberculosis.
abstract: BACKGROUND
  The rate of recurrent tuberculosis disease due to reinfection, compared with the incidence of new tuberculosis, in those with and without HIV infection is not known.
  
  
  METHODS
  In a retrospective cohort study of South African gold miners, men with known dates of seroconversion to HIV (from 1991 to 1997) and HIV-negative men were followed up to 2004. Rates of tuberculosis recurrence >2 years after the first episode were used as a proxy for reinfection disease rates.
  
  
  RESULTS
  Among 342 HIV-positive and 321 HIV-negative men who had had 1 previous episode of tuberculosis, rates of recurrence were 19.7 cases per 100 person-years at risk (PYAR; 95% confidence interval [CI], 16.4-23.7) and 7.7 cases per 100 PYAR (95% CI, 6.1-9.8), respectively. The recurrence rate did not vary by duration of HIV infection. Recurrent pulmonary tuberculosis rates >2 years after the first episode were 24.4 cases per 100 PYAR (95% CI, 17.2-34.8) in HIV-positive men and 4.3 cases per 100 PYAR (95% CI, 2.2-8.3) in HIV-negative men, compared with incidence rates of new pulmonary tuberculosis of 3.7 cases per 100 PYAR (95% CI, 3.3-4.1) in HIV-positive men and 0.75 cases per 100 PYAR (95% CI, 0.67-0.84) in HIV-negative men in the same cohort.
  
  
  CONCLUSIONS
  Tuberculosis recurrence rates, likely due to reinfection, were much higher than incidence rates. The findings suggest heterogeneity in susceptibility, implying that a vaccine could still provide useful protection in the population and strengthening the case for secondary preventive therapy.
authors.affiliation: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom. judith.glynn@lshtm.ac.uk
authors.forename: Judith R
authors.initials: JR
authors.lastname: Glynn
authors.forename: Jill
authors.initials: J
authors.lastname: Murray
authors.forename: Andre
authors.initials: A
authors.lastname: Bester
authors.forename: Gill
authors.initials: G
authors.lastname: Nelson
authors.forename: Stuart
authors.initials: S
authors.lastname: Shearer
authors.forename: Pam
authors.initials: P
authors.lastname: Sonnenberg
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology*