Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV: the current state of the problem

Abstract

Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an enhanced inflammatory immune response to Mycobacterium tuberculosis antigens due to immune system recovery in HIV-infected patients within 6 months of antiretroviral therapy (ART).
 Objective — to assess the incidence of TB-IRIS in patients with tuberculous meningitis. Evaluation of mortality caused by TB-IRIS.
 Materials and methods. A retrospective analysis of 60 cases of confirmed tuberculous meningitis in patients who were treated in anti-tuberculosis institutions in Kiev and Kiev region in 2017—2019 was carried out. The medical records of the patients were studied.Results and discussion. Co-infection with HIV-TB among patients was confirmed in 57 (95 %) cases. In 21 patients (36.8 %; CI 24.7—50.0 %) with HIV-TB co-infection, a link was established between the appointment of ART and the development of tuberculous meningitis. 19 (90.5 %) of them had risk factors at the time of ART. Fifteen (71.4 %) patients had other localizations of tuberculosis besides tuberculosis of the central nervous system (pulmonary tuberculosis, tuberculosis of intrathoracic lymph nodes, tuberculosis of peripheral lymph nodes, tuberculosis of the genitourinary system). The mean CD4+-lymphocyte count before ART was (61.6 ± 16.9) cells/µL (p ≤ 0.05). All patients were prescribed standard antimycobacterial therapy and ART. 9 (42.8 %) patients were cured. One (4.7 %) developed severe disability: peripheral tetraparesis and severe cerebrosthenia. 11 patients died, mortality was 52.4 % (CI 30.2—74.1 %).
 Conclusions. TB-IRIS is the cause of tuberculous meningitis in HIV-infected patients in 36.8 % of cases; (CI 24.7—50.0 %). Tuberculous meningitis always complicates the prognosis with TB-IRIS, while the mortality rate is 52.4 % (CI 30.2—74.1 %).