Abstract
BackgroundIn this study, we aimed to describe the prevalence, clinical presentation and risk factors of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) cases in China.MethodsWe performed a descriptive analysis of demographic and clinical data of HIV/TB coinfected patients receiving ART at Beijing Ditan Hospital between January 2014 and October 2018.ResultsOf 199 patients included, 45 (22.6%) developed paradoxical TB-IRIS, and 19 (9.5%) TB-IRIS cases presented miliary TB. The pre-ART CD4 count lower than 50 cells/mm3 was found to be significantly associated with development of TB-IRIS. Similarly, patients with higher than 4-fold increase in CD4 cell count after antiretroviral therapy (ART) had significantly higher odds of having TB-IRIS. When patients aged 25–44 years were utilized as the control group, youths (< 25 years old) were more likely to have miliary TB. No significant difference was observed in the intervals from initiation of ART to IRIS presentation between miliary and non-miliary group.ConclusionsIn conclusion, our data demonstrate that approximate one quarter of patients coinfected with TB and HIV develop paradoxical TB-IRIS after initial of ART therapy in China. Lower baseline CD4 count and rapid increase in CD4 count are the major risk factors associated with the occurrence of paradoxical TB-IRIS.
Highlights
In this study, we aimed to describe the prevalence, clinical presentation and risk factors of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) cases in China
The underlying immunological mechanisms of TB-RIIS are incompletely understood, a few clinical studies have demonstrated that risk factors for the development of TB-IRIS include low pre-Antiretroviral therapy (ART) CD4+ T cell counts, stronger CD4+ T cell increase after ART and short interval between starting antituberculous therapy and ART [7, 8], while the other studies did not find the relationship between these risk factors and developing IRIS [9]
Risk factors of miliary TB among TB-IRIS cases A total of 19 patients met the criteria for miliary TB
Summary
We aimed to describe the prevalence, clinical presentation and risk factors of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) cases in China. The underlying immunological mechanisms of TB-RIIS are incompletely understood, a few clinical studies have demonstrated that risk factors for the development of TB-IRIS include low pre-ART CD4+ T cell counts, stronger CD4+ T cell increase after ART and short interval between starting antituberculous therapy and ART [7, 8], while the other studies did not find the relationship between these risk factors and developing IRIS [9]. These contradictory results indicate that the small sample size of previous studies may negatively affect the generalization of these conclusions among different populations
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