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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Clinical spectrum, risk factors and outcome of immune reconstitution inflammatory syndrome in patients with tuberculosis-HIV coinfection
Antiviral Therapy, Volume 17, No. 5, Year 2012
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Description
Background: Here, we aimed to determine the clinical spectrum, predictors and outcomes of paradoxical tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) in a resource-limited setting. Methods: In a prospective cohort, we studied 254 patients with tuberculosis and HIV coinfection commencing antiretroviral therapy (ART). We identified patients with TB-IRIS using the International Network for Studies Against HIV-Associated IRIS (INSHI) case definition. Risk factors and clinical outcomes of TB-IRIS were determined and reported. Results: A total of 53 (21%) patients developed TB-IRIS a median of 2 weeks (IQR 12-22 days) after starting ART. The majority of the patients (70%) with TB-IRIS had extrapulmonary manifestations of TB-IRIS. In a multiple logistic regression model, baseline haemoglobin <100 g/l (OR 2.23 [95% CI 1.08-4.60]; P=0.031) and baseline CD4+ T-cell count <50 cells/μl (OR 4.13 [95% CI 1.80-9.51]; P=0.001) were significant predictors of IRIS. Seven additional patients fulfilled all INSHI criteria of TB-IRIS but had the episode of TB-IRIS later than 3 months after ART start. Conclusions: TB-IRIS was a frequent reason for clinical deterioration among patients with TB commencing ART but was not a primary contributor to mortality. Patients with advanced CD4 depletion and anaemia were at increased risk of TB-IRIS. Some patients developed late-onset TB-IRIS and/or a recurrent TB-IRIS episode. ©2012 International Medical Press.
Authors & Co-Authors
Worodria, William O.
Uganda, Kampala
Makerere University College of Health Sciences
Belgium, Antwerpen
Universiteit Antwerpen
Uganda, Kampala
Infectious Diseases Network for Treatment and Research in Africa
Menten, Joris
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Massinga-Loembé, Marguérite
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Mazakpwe, D.
Uganda, Kampala
Infectious Diseases Network for Treatment and Research in Africa
Bagenda, Danstan S.
Uganda, Kampala
Makerere University School of Public Health
Koole, Olivier
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Mayanja-Kizza, Harriet
Uganda, Kampala
Makerere University College of Health Sciences
Uganda, Kampala
Infectious Diseases Network for Treatment and Research in Africa
Kestens, Luc L.
Belgium, Antwerpen
Universiteit Antwerpen
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Mugerwa, Roy D.
Uganda, Kampala
Makerere University College of Health Sciences
Uganda, Kampala
Infectious Diseases Network for Treatment and Research in Africa
Reiss, Peter
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Colebunders, Robert Leon
Belgium, Antwerpen
Universiteit Antwerpen
Uganda, Kampala
Infectious Diseases Network for Treatment and Research in Africa
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Statistics
Citations: 38
Authors: 11
Affiliations: 6
Identifiers
Doi:
10.3851/IMP2108
ISSN:
13596535
Research Areas
Infectious Diseases
Study Design
Cohort Study