title: Immune reconstitution syndrome in patients treated for HIV and tuberculosis in Rio de Janeiro.
abstract: We made a retrospective longitudinal study from January 2000 to January 2003 to examine cases of immune reconstitution syndrome (IRS) and its incidence rate in tuberculosis (TB)-human immunodeficiency virus (HIV) co-infected patients. The incidence rate (IR) was calculated using a Poisson regression. The confidence interval (CI) that was stipulated was 95%. IRS occurred in 10/84 HIV and TB-positive patients; nine of them were on highly active anti-retroviral therapy (HAART) during a mean of 61.7 (+/- 59) days following the introduction of antiretrovirals. Lymph-node enlargement was the sole clinical manifestation. CD4 counts were <100 cells/mm(3)in 50% of the patients, at the time of TB diagnosis. All but two patients were treated with prednisone, and recovered from TB within a mean of 91 days (+/- 30 days). One relapse of TB was observed, but there were no IRS-related deaths. The incidence rate was higher (IR=11.18; CI, 1.41-88.76) in patients that had superficial lymph node enlargement at the moment of TB diagnosis (not associated with TB), extrapulmonary TB (IR=1.97; CI, 0.44-8.79), were antiretroviral naive (IR=1.85; CI, 0.48-7.16), and CD4 counts <100 cells/mm(3) (IR=1.50; CI, 0.40-5.59), although with a wide CI. IRS was frequent in our sample, occurred more frequently in HIV-naive patients with lymph-node enlargement and extrapulmonary TB. No cases of new pulmonary lesions or worsening of pulmonary infiltrates were observed.
authors.affiliation: Evandro Chagas Research Institute-Fiocruz, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, Brazil.
authors.forename: Fabiana C
authors.initials: FC
authors.lastname: Serra
authors.forename: David
authors.initials: D
authors.lastname: Hadad
authors.forename: Renata L
authors.initials: RL
authors.lastname: Orofino
authors.forename: Flavia
authors.initials: F
authors.lastname: Marinho
authors.forename: Cristina
authors.initials: C
authors.lastname: Lourenço
authors.forename: Mariza
authors.initials: M
authors.lastname: Morgado
authors.forename: Valeria
authors.initials: V
authors.lastname: Rolla
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000276:immunology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000276:immunology*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000276:immunology*; D019562:Viral Load
chemical_list: D000995:Antitubercular Agents