title: Evaluation of paradoxical TB-associated IRIS with the use of standardized case definitions for resource-limited settings.
abstract: OBJECTIVE
  Standardized case definitions have recently been proposed by the International Network for the Study of HIV-associated immune reconstitution inflammatory syndrome (INSHI; [IRIS]) for use in resource-limited settings. We evaluated paradoxical tuberculosis (TB)-associated IRIS in a large cohort from a TB endemic setting with the use of these case definitions.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  We reviewed records from 1250 South African patients who initiated antiretroviral therapy (ART) over a 5-year period.
  
  
  RESULTS
  A total of 333 (27%) of the patients in the cohort had prevalent TB at the initiation of ART. Of 54 possible paradoxical TB-associated IRIS cases, 35 fulfilled the INSHI case definitions (11% of TB cases).
  
  
  CONCLUSIONS
  INSHI-standardized case definitions were used successfully in identifying paradoxical TB-associated IRIS in this cohort and resulted in a similar proportion of TB IRIS cases (11%) as that reported in previous studies from resource-limited settings (8%-13%). This case definition should be evaluated prospectively.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa. wilson.ingrid@gmail.com
authors.forename: Ingrid
authors.initials: I
authors.lastname: Eshun-Wilson
authors.forename: Fiona
authors.initials: F
authors.lastname: Havers
authors.forename: Jean B
authors.initials: JB
authors.lastname: Nachega
authors.forename: Hans W
authors.initials: HW
authors.lastname: Prozesky
authors.forename: Jantjie J
authors.initials: JJ
authors.lastname: Taljaard
authors.forename: Michele D
authors.initials: MD
authors.lastname: Zeier
authors.forename: Mark
authors.initials: M
authors.lastname: Cotton
authors.forename: Gary
authors.initials: G
authors.lastname: Simon
authors.forename: Patrick
authors.initials: P
authors.lastname: Soentjens
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D015497:HIV-1; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000209:etiology / Q000276:immunology / Q000503:physiopathology; D008297:Male; D009169:Mycobacterium tuberculosis; D012015:Reference Standards; D012189:Retrospective Studies; D013019:South Africa; D014376:Tuberculosis / Q000150:complications* / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology
chemical_list: D019380:Anti-HIV Agents