Worsening and unmasking of tuberculosis in HIV-1 infected patients after initiating highly active anti-retroviral therapy in Uganda.
OBJECTIVE
To determine the proportion of patients developing active tuberculosis (TB) versus that of patients who experience worsening of TB, after initiating highly active anti retroviral therapy (HAART).


METHODS
Charts of HAART naïve patients with or without clinically active TB who consecutively commenced HAART at Mulago Hospital Infectious Diseases Institute were reviewed. Patients were assessed for worsening of TB on treatment or development of new active TB (unmasking of TB) after initiating HAART.


RESULTS
Of 271 patients without active TB at baseline who initiated HAART, 16 (5.9%) developed active TB within 6 months (early unmasking) and 10 (2.7%) after 6 months (late unmasking). Seven of 10 late unmasking patients had a past history of treatment for a TB disease episode. Of 45 patients who commenced HAART with coexisting active TB, 13 (29%) experienced worsening of TB symptoms, signs and/or radiological features. Nine of these 45 commenced HAART during the intensive phase of TB treatment, of whom 2 (22%) experienced worsening of TB. Thirty six of 45 started HAART during the continuation phase of TB treatment of whom 11 (31%), experienced worsening of TB. The median time from initiation of HAART to worsening of TB in patients on concurrent active TB treatment was 5 weeks, and 18 weeks to unmasking of new active tuberculosis.


CONCLUSIONS
Unmasking of TB was commonest in the first 6 months of HAART and declined in the subsequent months with most in the late unmasking group being TB recurrences. Worsening of TB occurred even after HAART was delayed to the continuation phase of TB treatment.
Baalwa
Joshua
J
Makerere University, Infectious Diseases Institute, Kampala, Uganda. jbaalwa@yahoo.com
Mayanja-Kizza
Harriet
H
Kamya
Moses R
MR
John
Laurence
L
Kambugu
Andrew
A
Colebunders
Robert
R
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014454:Uganda
D019380:Anti-HIV Agents; D000995:Antitubercular Agents