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A Nested Case–Control Study on Treatment-related Risk Factors for Early Relapse of Tuberculosis

Tuberculosis and Chest Service, Department of Health; Tuberculosis and Chest Unit, Grantham Hospital; and Department of Community and Family Medicine, School of Public Health, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China

Correspondence and requests for reprints should be addressed to Dr. Kwok Chiu Chang, Yaumatei Chest Clinic, 2/F, Yaumatei Jockey Club Polyclinic, 145, Battery Street, Kowloon, Hong Kong, China. E-mail: ymtcc{at}dh.gov.hk

This nested case–control study aimed at evaluating treatment-related risk factors of relapse of tuberculosis under a service program of directly observed treatment. Out of 12,183 patients with pulmonary tuberculosis who completed treatment within 1 year, 113 relapsed within 30 months after commencement of therapy. The overall 30-month relapse rate was 0.9% (95% confidence interval [CI] 0.8–1.1%). On matching 113 cases with 226 control subjects in a conditional logistic model, thrice-weekly treatment increased the risk of relapse in comparison with daily treatment (odds ratio 3.92, 95% CI 1.78–8.63), whereas prolonging both intensive phase and overall treatment by 50% or more protected against relapse (odds ratio 0.24, 95% CI 0.08–0.70). When pretreatment culture was positive and cavitation was absent, the 30-month relapse rate for standard thrice-weekly regimen was 1.1% (95% CI 0.6–2.0%). The corresponding rates in the presence of cavitation were 7.8% (95% CI 4.0–14.6%) for standard thrice-weekly regimen; 3.3% (95% CI 1.9–5.5%) for standard daily regimen; 0.5% (95% CI 0.1–2.6%) for extended thrice-weekly regimen; and 0.4% (95% CI 0.1–0.9%) for extended daily regimen. Further studies are required to reduce the risk of relapse under program settings.

Key Words: logistic models • recurrence • risk factors • therapeutics • tuberculosis

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