Recurrent TB: a systematic review and meta-analysis of the incidence rates and the proportions of relapses and reinfections
| Autor: | Patrick Van der Stuyft, Victor Vega, Larissa Otero, Carlos Seas, Sharon Rodríguez |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Tuberculosis Genotype REGIMENS Article 03 medical and health sciences 0302 clinical medicine Recurrence Risk Factors respiratory infection EXOGENOUS REINFECTION Internal medicine INFECTION Medicine and Health Sciences medicine Humans 030212 general & internal medicine Tuberculosis Pulmonary Genotyping 0303 health sciences 030306 microbiology business.industry Incidence Incidence (epidemiology) Respiratory infection clinical epidemiology medicine.disease tuberculosis Sample size determination Reinfection Meta-analysis Methodological study business Tb treatment |
| Zdroj: | THORAX Thorax |
| ISSN: | 1468-3296 0040-6376 |
| DOI: | 10.1136/thoraxjnl-2020-215449 |
| Popis: | BackgroundA recurrent tuberculosis (TB) episode results from exogenous reinfection or relapse after cure. The use of genotyping allows the distinction between both.MethodsWe did a systematic review and meta-analysis, using four databases to search for studies in English, French and Spanish published between 1 January 1980 and 30 September 2020 that assessed recurrences after TB treatment success and/or differentiated relapses from reinfections using genotyping. We calculated person years of follow-up and performed random-effects model meta-analysis for estimating pooled recurrent TB incidence rates and proportions of relapses and reinfections. We performed subgroup analyses by clinical–epidemiological factors and by methodological study characteristics.FindingsThe pooled recurrent TB incidence rate was 2.26 per 100 person years at risk (95% CI 1.87 to 2.73; 145 studies). Heterogeneity was high (I2=98%). Stratified pooled recurrence rates increased from 1.47 (95% CI 0.87 to 2.46) to 4.10 (95% CI 2.67 to 6.28) per 100 person years for studies conducted in low versus high TB incidence settings. Background HIV prevalence, treatment drug regimen, sample size and duration of follow-up contributed too. The pooled proportion of relapses was 70% (95% CI 63% to 77%; I²=85%; 48 studies). Heterogeneity was determined by background TB incidence, as demonstrated by pooled proportions of 83% (95% CI 75% to 89%) versus 59% (95% CI 42% to 74%) relapse for studies from settings with low versus high TB incidence, respectively.InterpretationThe risk of recurrent TB is substantial and relapse is consistently the most frequent form of recurrence. Notwithstanding, with increasing background TB incidence the proportion of reinfections increases and the predominance of relapses among recurrences decreases.PROSPERO registration numberCRD42018077867 |
| Databáze: | OpenAIRE |
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