Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection.
BACKGROUND
It has been suggested that deterioration of tuberculosis (TB) during appropriate treatment, termed a paradoxical reaction (PR), is more common and severe in HIV positive individuals on highly active antiretroviral therapy (HAART).


METHODS
A study was undertaken to determine the frequency of PR and its associated features in a population of HIV+TB+ patients and a similar sized group of HIV-TB+ individuals.


RESULTS
PR occurred in 28% of 50 HIV+TB+ patients and 10% of 50 HIV-TB+ patients. Disseminated TB was present in eight of 13 HIV+TB+ patients and four of five HIV-TB+ patients with PR. In 28 HIV+TB+ patients starting HAART, PR was significantly associated with commencing HAART within 6 weeks of starting antituberculosis treatment (p = 0.03) and was more common in those with disseminated TB (p = 0.09). No association was found between development of PR and baseline CD4 count or CD4 response to HAART.


CONCLUSIONS
PR is common in HIV infected and uninfected individuals with TB. Early introduction of HAART and the presence of disseminated TB appear to be important in co-infected patients.
Department of Thoracic and HIV Medicine, Royal Free Hospital, London NW3 2QG, UK. rambreen@doctors.org.uk
R A M
RA
Breen
C J
CJ
Smith
H
H
Bettinson
S
S
Dart
B
B
Bannister
M A
MA
Johnson
M C I
MC
Lipman
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents; D002097:C-Reactive Protein