TB Iris: A clinical outcome among HIV patients receiving antiretroviral therapy in a tuberculosis prevelant area

Abstract

Introduction:IRIS remains as a major obstacle in effective administration of antiretroviral therapy. This study primarily focuses on evaluating the frequency of occurrence of TB-IRIS among HIV patients on antiretroviral therapy. Secondly, it focuses on establishing risk factors or predictors in patients developing TB-IRIS and finally this study aims to determine the various clinical outcomes and effect of IRIS development on survival rates among these patient. Materials & Method:This study is retrospective hospital based executed in the ART centre in Mangalore, Karnataka. Diagnosis of TB-IRIS was made as per INSHI consensus case definition provided for resource-limited settings. The Data from January 2008 till September 2012 was evaluated via semi-structured questionnaire. Inclusion Criteria Patients eligible to receive ART and were above the age of 18. Those patients who were non-compliant with treatment or HIV patients no ton ART were excluded from our sample population Results:A total of 125 patients were included in this study. 37(29.6%) had diagnosed TB before starting the treatment. 6(16.2%) out of the 37 HIV with combined TB patients progressed to paradoxical TB-IRIS when ART drugs were initiated. 88(70.4%) patients did not have active TB when ART was started, among whom 6 patients developed “unmasking” TB-IRIS. 8 (66.7%) out of the 12 patients developed IRIS in a period of three months of initiation of ART rest 4 (33.3%) patients developed after the three month period. 10 (83.33%)out of the 12 patients were male. 5 out of the 6 patients with paradoxical TB-IRIS had extra-pulmonary TB at the time of ART initiation. Conclusion: Consensus case definition for the resource limited setting is an effective tool in the diagnosis of TB-IRIS. TB-IRIS can be treated conservatively and although not fatal early diagnosis and management can prevent a complicated course of disease.