title: Relapse more common than reinfection in recurrent tuberculosis 1-2 years post treatment in urban Uganda.
abstract: OBJECTIVE
  To determine the proportion of recurrent tuberculosis (TB) due to relapse with the patient's initial strain or reinfection with a new strain of Mycobacterium tuberculosis 1-2 years after anti-tuberculosis treatment in Uganda, a sub-Saharan TB-endemic country.
  
  
  METHODS
  Records of patients with culture-confirmed TB who completed treatment at an urban Ugandan clinic were reviewed. Restriction fragment length polymorphism (RFLP) patterns were used to determine relapse or reinfection. Associations between human immunodeficiency virus (HIV) positivity and type  of TB recurrence were determined.
  
  
  RESULTS
  Of 1701 patients cured of their initial TB episode with a median follow-up of 1.24 years, 171 (10%) had TB recurrence (8.4 per 100 person-years). Rate and risk factors for recurrence were similar to other studies from sub-Saharan Africa. Insertion  sequence (IS) 6110-based RFLP of paired isolates from 98 recurrences identified 80 relapses and 18 reinfections. Relapses among HIV-positive and -negative patients were respectively 79% and 85% of recurrences.
  
  
  CONCLUSIONS
  Relapse was more common and presented earlier than reinfection  in both HIV-positive and -negative TB patients 1-2 years after completing treatment. These findings impact both the choice of retreatment drug regimen, as relapsing patients are at higher risk for acquired drug resistance, and clinical trials of new TB regimens with relapse as clinical  endpoint.
authors: National Tuberculosis and Leprosy Program, Mulago Hospital and Complex, Kampala, Uganda.
authors: H
authors: H
authors: Luzze
authors: D F
authors: DF
authors: Johnson
authors: K
authors: K
authors: Dickman
authors: H
authors: H
authors: Mayanja-Kizza
authors: A
authors: A
authors: Okwera
authors: K
authors: K
authors: Eisenach
authors: M D
authors: MD
authors: Cave
authors: C C
authors: CC
authors: Whalen
authors: J L
authors: JL
authors: Johnson
authors: W H
authors: WH
authors: Boom
authors: M
authors: M
authors: Joloba
mesh_terms: D000328:Adult; D054458:Amplified Fragment Length Polymorphism Analysis; D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection; D019353:Endemic Diseases; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000472:pathogenicity*; D010641:Phenotype; D012150:Polymorphism, Restriction Fragment Length; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014454:Uganda / Q000453:epidemiology; D014504:Urban Health
chemical_list: D000995:Antitubercular Agents; D012293:Rifampin