Glynn JR, Murray J, Bester A, Nelson G, Shearer S, Sonnenberg P.
J Infect Dis, 2010. 201(5): p. 704-11.
This is a major article, recently published in the Journal of Infectious Diseases, together with an editorial commentary about recurrent tuberculosis.
HIV-infected individuals have a very high risk of contracting tuberculosis. An episode of tuberculosis may be a new infection or a recurrent infection (which may be the result of relapse of the original infection, or reinfection by a different strain of the tuberculosis bacillus). The aim of the study was to look at rates of recurrence in a large cohort of HIV-infected and uninfected gold miners in South Africa. The two groups were followed up for more than 10 years, from 1991 to 2004 when the mining company introduced an antiretroviral treatment programme.
The study demonstrated that recurrent tuberculosis is exceedingly common in both HIV-infected and uninfected South African gold miners. Rates of reinfection were much higher than those of new infections, in both groups, but were almost six times higher in the HIV-infected than the uninfected miners.
An accompanying article1 in the same issue of the journal looked at an HIV-infected population in India, and also found a high tuberculosis recurrence rate. The management implications of these results, including secondary preventive therapy with isoniazid, are discussed in an editorial commentary2 in this issue.