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. 2013 Jun 11;8(6):e64898.
doi: 10.1371/journal.pone.0064898. Print 2013.

Tuberculosis recurrence after completion treatment in a European city: reinfection or relapse?

Juan-Pablo Millet  1 , Evelyn Shaw, Angels Orcau, Martí Casals, Jose M Miró, Joan A Caylà; Barcelona Tuberculosis Recurrence Working Group
Affiliations

Tuberculosis recurrence after completion treatment in a European city: reinfection or relapse?

Juan-Pablo Millet et al. PLoS One. .

Abstract

Background: Tuberculosis (TB) recurrence can be due to reinfection or relapse. The contribution of each to TB incidence and the factors associated with recurrence are not well known. Effectiveness of TB control programs is assessed in part by recurrence rates. The aim of this study was to establish the recurrence rate of TB in Barcelona, the associated risk factors and the role of reinfection.

Methods: A population-based retrospective longitudinal study was performed in Barcelona, Spain. TB patients with positive culture results who completed treatment between Jan 1(st), 2003 and Dec 31(st), 2006 were followed-up until December 31st, 2009 by the TB Control Program. The incidence rate of recurrence was calculated per person-year of follow-up (py). Kaplan-Meier and Cox regression methods were used for the survival analysis by calculating the hazard ratio (HR) with 95% confidence intervals (CI).

Results: Of the 1,823 TB cases identified, 971 fulfilled the inclusion criteria and 13 (1.3%) had recurrent TB. The recurrence rate was 341 cases per 100,000 py, 13 times higher than the TB incidence of the general population. Likelihood of TB recurrence at the 1st, 3rd and 5th year of follow-up was 0.1%, 1.4% and 1.6%, respectively. Factors associated with recurrence were HIV infection (HR: 4.7, CI: 1.4-15.7), living in the inner city district (HR: 3.9, CI: 1.3-11.8) and history of TB treatment (HR: 5.2, CI: 1.7-16.2). Genotyping results of recurrent cases were available for 6 patients (3 reinfections and 3 relapses).

Conclusion: The rate of TB recurrence in Barcelona is low and most episodes occur within the first three years. Patients at higher risk of recurrence are co-infected with HIV, living in neighborhoods with high TB incidence or with a history of TB treatment. When available, genotyping results help determine whether the recurrence is due to reinfection or relapse.

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Conflict of interest statement

Competing Interests: Dr. Joan A. Caylà is a PLOS ONE Editorial Board member. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. The flow chart of tuberculosis patient selection and evolution.
Barcelona 2003–2009.
Figure 2
Figure 2. Kaplan-Meier curves of the risk of tuberculosis recurrence among patients with HIV infection, history of TB treatment and who live in the inner-city district.
Barcelona 2003–2009.
See this image and copyright information in PMC

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