title: Clinical spectrum, risk factors and outcome of immune reconstitution inflammatory syndrome in patients with tuberculosis-HIV coinfection.
abstract: BACKGROUND
  Here, we aimed to determine the clinical spectrum, predictors and outcomes of paradoxical tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) in a resource-limited setting.
  
  
  METHODS
  In a prospective cohort, we studied 254 patients with tuberculosis and HIV coinfection commencing antiretroviral therapy (ART). We identified patients with TB-IRIS using the International Network for Studies Against HIV-Associated IRIS (INSHI) case definition. Risk factors and clinical outcomes of TB-IRIS were determined and reported.
  
  
  RESULTS
  A total of 53 (21%) patients developed TB-IRIS a median of 2 weeks (IQR 12-22 days) after starting ART. The majority of the patients (70%) with TB-IRIS had extrapulmonary manifestations of TB-IRIS. In a multiple logistic regression model, baseline haemoglobin <100 g/l (OR 2.23 [95% CI 1.08-4.60]; P=0.031) and baseline CD4(+) T-cell count <50 cells/μl (OR 4.13 [95% CI 1.80-9.51]; P=0.001) were significant predictors of IRIS. Seven additional patients fulfilled all INSHI criteria of TB-IRIS but had the episode of TB-IRIS later than 3 months after ART start.
  
  
  CONCLUSIONS
  TB-IRIS was a frequent reason for clinical deterioration among patients with TB commencing ART but was not a primary contributor to mortality. Patients with advanced CD4 depletion and anaemia were at increased risk of TB-IRIS. Some patients developed late-onset TB-IRIS and/or a recurrent TB-IRIS episode.
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda. worodria@yahoo.com
authors.forename: William
authors.initials: W
authors.lastname: Worodria
authors.forename: Joris
authors.initials: J
authors.lastname: Menten
authors.forename: Marguerite
authors.initials: M
authors.lastname: Massinga-Loembe
authors.forename: Doreen
authors.initials: D
authors.lastname: Mazakpwe
authors.forename: Danstan
authors.initials: D
authors.lastname: Bagenda
authors.forename: Olivier
authors.initials: O
authors.lastname: Koole
authors.forename: Harriet
authors.initials: H
authors.lastname: Mayanja-Kizza
authors.forename: Luc
authors.initials: L
authors.lastname: Kestens
authors.forename: Roy
authors.initials: R
authors.lastname: Mugerwa
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000150:complications* / Q000188:drug therapy; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents