National Tuberculosis and Leprosy Program, Mulago Hospital and Complex, Kampala, Uganda.
Int J Tuberc Lung Dis. 2013 Mar;17(3):361-7. doi: 10.5588/ijtld.11.0692.
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.
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.
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.
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.
在乌干达这个撒哈拉以南的结核病流行国家，确定在抗结核治疗后 1-2 年内，因初始菌株复发或新结核分枝杆菌菌株再感染导致复发性结核病（TB）的比例。
回顾了在乌干达一家城市诊所接受治疗并已治愈的培养确诊 TB 患者的记录。使用限制性片段长度多态性（RFLP）模式来确定复发或再感染。确定人类免疫缺陷病毒（HIV）阳性与 TB 复发类型之间的关联。
在 1701 名初始 TB 发作患者中，171 名（10%）在中位随访 1.24 年后出现 TB 复发（100 人年 8.4 例）。复发的发生率和危险因素与撒哈拉以南非洲的其他研究相似。从 98 例复发中分离出的配对分离株的插入序列（IS）6110 基于 RFLP，确定了 80 例复发和 18 例再感染。HIV 阳性和阴性患者的复发分别占复发的 79%和 85%。
在完成治疗后 1-2 年内，HIV 阳性和阴性 TB 患者的复发比再感染更为常见且更早出现。这些发现对复发性患者获得药物耐药性风险更高的复发性患者的再治疗药物方案选择以及以复发作为临床终点的新 TB 方案的临床试验都有影响。
