Nine-to twelve-month anti-tuberculosis treatment is associated with a lower recurrence rate than 6-9-month treatment in human immunodeficiency virus-infected patients

A retrospective population-based cohort study in Taiwan

Jann Yuan Wang, Hsin Yun Sun, Jann Tay Wang, Chien Ching Hung, Ming Chih Yu, Chih Hsin Lee, Li Na Lee

研究成果: 雜誌貢獻文章

5 引文 (Scopus)

摘要

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 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.

原文英語
文章編號e0144136
期刊PLoS One
10
發行號12
DOIs
出版狀態已發佈 - 十二月 1 2015

指紋

Human immunodeficiency virus
cohort studies
Taiwan
Viruses
tuberculosis
Tuberculosis
Cohort Studies
HIV
Recurrence
Population
Regression analysis
Sensitivity analysis
Hazards
Directly Observed Therapy
Therapeutics
Health insurance
therapeutics
regression analysis
Regression Analysis
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

引用此文

@article{0ab61f7864834220b69ee5b217f607f9,
title = "Nine-to twelve-month anti-tuberculosis treatment is associated with a lower recurrence rate than 6-9-month treatment in human immunodeficiency virus-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 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.",
author = "Wang, {Jann Yuan} and Sun, {Hsin Yun} and Wang, {Jann Tay} and Hung, {Chien Ching} and Yu, {Ming Chih} and Lee, {Chih Hsin} and Lee, {Li Na}",
year = "2015",
month = "12",
day = "1",
doi = "10.1371/journal.pone.0144136",
language = "English",
volume = "10",
journal = "PLoS One",
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TY - JOUR

T1 - Nine-to twelve-month anti-tuberculosis treatment is associated with a lower recurrence rate than 6-9-month treatment in human immunodeficiency virus-infected patients

T2 - A retrospective population-based cohort study in Taiwan

AU - Wang, Jann Yuan

AU - Sun, Hsin Yun

AU - Wang, Jann Tay

AU - Hung, Chien Ching

AU - Yu, Ming Chih

AU - Lee, Chih Hsin

AU - Lee, Li Na

PY - 2015/12/1

Y1 - 2015/12/1

N2 - 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 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.

AB - 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 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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