Immune reconstitution inflammatory syndrome of tuberculosis among HIV-infected patients receiving antituberculous and antiretroviral therapy.
OBJECTIVE
To determine the frequency, risk factors and mortality rate of immune reconstitution inflammatory syndrome (IRIS) of tuberculosis (TB) in patients co-infected with HIV/TB and receiving antiretroviral therapy (ART).


METHODS
A retrospective study was conducted in Bamrasnaradura Infectious Diseases Institute and Ramathibodi Hospital, Thailand.


RESULTS
There were 167 patients with a mean age of 34.5 years. Median (IQR) CD4 cell counts was 36 (15-69) cells/mm(3) and median (IQR) HIV RNA was 427,000 (189,000-750,000) copies/ml. ART was initiated at a median (IQR) duration of 2.2 (1.4-3.7) months after TB treatment. IRIS was identified in 21 (12.6%) patients. Patients with IRIS had a higher proportion of extrapulmonary TB than patients without IRIS (P<0.001). By multivariate analysis, extrapulmonary TB was a risk factor for IRIS (odds ratio=8.225, 95% confidence interval=1.785-37.911, P=0.007). Of 21 patients with IRIS, 15 patients developed IRIS within the first two months of ART. The mortality rate in patients with and without IRIS was not different (9.5% versus 2.1%, P=0.119).


CONCLUSIONS
The rate of TB IRIS is 13% in patients co-infected with HIV and TB. Extrapulmonary TB is a risk factor for IRIS. Closely monitored clinical care in the first few months of ART initiation and further interventional studies to minimize mortality of TB IRIS are needed.
Manosuthi
Weerawat
W
Department of Medicine, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand. idweerawat@yahoo.com <idweerawat@yahoo.com>
Kiertiburanakul
Sasisopin
S
Phoorisri
Thanongsri
T
Sungkanuparph
Somnuek
S
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000209:etiology / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D013785:Thailand / Q000453:epidemiology; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality
D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents