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.
Department of Medicine, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand. idweerawat@yahoo.com <idweerawat@yahoo.com>
Weerawat
W
Manosuthi
Sasisopin
S
Kiertiburanakul
Thanongsri
T
Phoorisri
Somnuek
S
Sungkanuparph
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