Abstract
BackgroundThe incidence, manifestations, outcome and clinical predictors of paradoxical TB-IRIS in patients with HIV and culture confirmed pulmonary tuberculosis (PTB) in India have not been studied prospectively.MethodsHIV+ patients with culture confirmed PTB started on anti-tuberculosis therapy (ATT) were followed prospectively after anti-retroviral therapy (ART) initiation. Established criteria for IRIS diagnosis were used including decline in plasma HIV RNA at IRIS event. Pre-ART plasma levels of interleukin (IL)-6 and C-reactive protein (CRP) were measured. Univariate and multivariate logistic regression models were used to evaluate associations between baseline variables and IRIS.ResultsOf 57 patients enrolled, 48 had complete follow up data. Median ATT-ART interval was 28 days (interquartile range, IQR 14–47). IRIS events occurred in 26 patients (54.2%) at a median of 11 days (IQR: 7–16) after ART initiation. Corticosteroids were required for treatment of most IRIS events that resolved within a median of 13 days (IQR: 9–23). Two patients died due to CNS TB-IRIS. Lower CD4+ T-cell counts, higher plasma HIV RNA levels, lower CD4/CD8 ratio, lower hemoglobin, shorter ATT to ART interval, extra-pulmonary or miliary TB and higher plasma IL-6 and CRP levels at baseline were associated with paradoxical TB-IRIS in the univariate analysis. Shorter ATT to ART interval, lower hemoglobin and higher IL-6 and CRP levels remained significant in the multivariate analysis.ConclusionParadoxical TB–IRIS frequently complicates HIV-TB therapy in India. IL-6 and CRP may assist in predicting IRIS events and serve as potential targets for immune interventions.
Highlights
Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is the paradoxical worsening of clinical symptoms, signs and radiological features of TB upon initiation of antiretroviral therapy (ART) after a temporal improvement with anti-tuberculosis therapy (ATT) [1]
As findings from large prospective studies and clinical trials have demonstrated that delaying ART can result in increased overall mortality risk associated with AIDS [2,4,7,12,13,14], new guidelines recommend early ART initiation in patients with tuberculosis and severe CD4+ T-cell depletion [15]
Eligible participants for the sub-study had to be above 18 years of age, HIV+ with pulmonary TB confirmed by sputum cultures, harboring rifampicin sensitive Mycobacterium tuberculosis at baseline, ART naıve, willing to take drugs under supervision, and willing to sign informed consent
Summary
Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is the paradoxical worsening of clinical symptoms, signs and radiological features of TB upon initiation of antiretroviral therapy (ART) after a temporal improvement with anti-tuberculosis therapy (ATT) [1]. This clinical scenario develops despite successful suppression of HIV viremia accompanied by increased CD4+ T-cell counts in the blood [1,2,3]. The incidence, manifestations, outcome and clinical predictors of paradoxical TB-IRIS in patients with HIV and culture confirmed pulmonary tuberculosis (PTB) in India have not been studied prospectively
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
