Nine- to twelve-month anti-TB treatment is associated with a lower recurrence rate than 6–9-month treatment in HIV-infected patients: A retrospective population-based cohort study in Taiwan
Abstract
Background
Human immunodeficiency
virus (HIV)-infected patients are at an increased risk of
tuberculosis (TB) and its recurrence following completion of
anti-TB treatment. We investigated whether extending anti-TB
treatment to 9 months or longer reduces TB recurrence.
Methods
HIV-infected patients who
were diagnosed with pulmonary TB between 1997 and 2009 and who
received anti-TB treatment for a duration between 5.5 and 12.5
months were identified from the National Health Insurance
Research Database in Taiwan. Those who received any
non-fluoroquinolone second-line anti-TB drug for >28 days
were excluded. Factors associated with TB recurrence within 2
years after completion of anti-TB treatment were explored using
Cox regression analysis. Sensitivity analysis was performed for
a subpopulation fulfilling strict diagnostic criteria for HIV
infection.
Results
TB recurrence was observed
in 18 (3.5%) of 508 HIV-infected patients. The recurrence rate
declined from 5.4% to 1.0% after the implementation of directly
observed therapy, short course (DOTS) in 2006 (p = 0.014). The
recurrence rate was 5.9%, 5.2%, and 1.6% in patients who
received anti-TB treatment for <195, 195–270, and
>270 days, respectively (p = 0.066). Cox regression analysis
revealed that TB diagnosed in the DOTS era (hazard ratio [HR]:
0.18 [0.04–0.77]) and anti-TB treatment for >270 days
(HR: 0.24 [0.06–0.89]) were associated with a reduced risk
of TB recurrence. Sensitivity analysis of 449 selected patients
revealed that anti-TB treatment for >270 days was a
significant factor.
Conclusion
In Taiwan, the 2-year TB
recurrence rate in HIV-infected patients declined after
implementation of DOTS. The risk of TB recurrence in
HIV-infected patients can be further reduced by extending
anti-TB treatment to 9–12.5 months.
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Source:
PLOS ONE
