Frequency, severity and duration of immune reconstitution events in HIV-related tuberculosis.
METHODS
Patients were enrolled in a prospective trial of rifabutin-based tuberculosis (TB) treatment for human immunodeficiency virus related TB. Antiretroviral therapy (ART) was encouraged, but not required.


OBJECTIVE
To evaluate the frequency, risk factors and duration of immune reconstitution events.


METHODS
Patients were prospectively evaluated for immune reconstitution events, and all adverse event reports were reviewed to identify possible unrecognized events.


RESULTS
Of 169 patients, 25 (15%) developed immune reconstitution events related to TB. All 25 were among the 137 patients who received ART during TB treatment, so the frequency in this subgroup was 18% (25/137). Risk factors for an immune reconstitution event in multivariate analysis were Black race, the presence of extra-pulmonary TB and a shorter interval from initiation of TB treatment to initiation of ART. The most common clinical manifestations were fever (64%), new or worsening adenopathy (52%) and worsening pulmonary infiltrates (40%). Twelve patients (48%) were hospitalized for a median of 7 days, six underwent surgery and 11 had needle aspiration. The median duration of events was 60 days (range 11-442).


CONCLUSIONS
Immune reconstitution events were common among patients receiving ART during TB treatment, produced substantial morbidity and had a median duration of 2 months.
Burman
W
W
Denver Public Health and the University of Colorado Health Sciences Center, Denver, Colorado 80204, USA. bburman@dhha.org
Weis
S
S
Vernon
A
A
Khan
A
A
Benator
D
D
Jones
B
B
Silva
C
C
King
B
B
LaHart
C
C
Mangura
B
B
Weiner
M
M
El-Sadr
W
W
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000276:immunology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017828:Rifabutin / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000276:immunology*
D000995:Antitubercular Agents; D017828:Rifabutin