title: Tuberculosis (TB)-associated immune reconstitution inflammatory syndrome in TB-HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes.
abstract: Background Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important early complication of antiretroviral therapy (ART) in countries with high rates of endemic TB, but data from South-East Asia are incomplete. Identification of prevalence, risk factors and treatment outcomes of TB-IRIS in Malaysia was sought.
  
  
  METHODS
  A 3-year retrospective study was conducted among TB-HIV co-infected patients treated at the University of Malaya Medical Centre. Simple and adjusted logistic regressions were used to identify the predictors for TB-IRIS while Cox regression was used to assess the influence of TB-IRIS on long-term CD4 T-cell recovery.
  
  
  RESULTS
  One hundred and fifty-three TB-HIV patients were enrolled, of whom 106 had received both anti-TB treatment (ATT) and ART. The median (IQR) baseline CD4 T-cell count was 52 cells μL(-1) (13-130 cells μL(-1)). Nine of 96 patients (9.4%) developed paradoxical TB-IRIS and eight developed unmasking TB-IRIS, at a median (IQR) time of 27 (12-64) and 19 (14-65) days, respectively. In adjusted logistic regression analysis, only disseminated TB was predictive of TB-IRIS [OR: 10.7 (95% CI: 1.2-94.3), P=0.032]. Mortality rates were similar for TB-IRIS (n=1, 5.9%) and non-TB-IRIS (n=5, 5.7%) patients and CD4 T-cell recovery post-ART was not different between the two groups (P=0.363).
  
  
  CONCLUSIONS
  Disseminated TB was a strong independent predictor of TB-IRIS in Malaysian HIV-TB patients after commencing ART. This finding underscores the role of a high pathogen load in the pathogenesis of TB-IRIS; so interventions that reduce pathogen load before ART may benefit HIV patients with disseminated TB.
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Hong Yien
authors.initials: HY
authors.lastname: Tan
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Yean Kong
authors.initials: YK
authors.lastname: Yong
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Sin How
authors.initials: SH
authors.lastname: Lim
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Sasheela
authors.initials: S
authors.lastname: Ponnampalavanar
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Sharifah F S
authors.initials: SF
authors.lastname: Omar
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Yong Kek
authors.initials: YK
authors.lastname: Pang
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
authors.affiliation: Translational Immunology Unit, School of Pathology and Laboratory Medicine, University of Western Australia, Level 2, Medical Research Foundation Building, Rear 50 Murray Street, Perth, WA 6000, Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Price
authors.affiliation: Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Crowe
authors.affiliation: Translational Immunology Unit, School of Pathology and Laboratory Medicine, University of Western Australia, Level 2, Medical Research Foundation Building, Rear 50 Murray Street, Perth, WA 6000, Australia.
authors.forename: Martyn A
authors.initials: MA
authors.lastname: French