Incidence and risk factors of immune reconstitution inflammatory syndrome in HIV-TB coinfected patients

• Published in: The Brazilian journal of infectious diseases Vol. 15; no. 6; pp. 553 - 559
• Main Authors: De, Dibyendu, Nath Sarkar, Rathindra, Phaujdar, Sibaji, Bhattacharyya, Kuntal, Krishna Pal, Hare
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier Editora Ltda 01.11.2011; Contexto; Elsevier
• Subjects: Adult; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - epidemiology; Anti-Retroviral Agents - adverse effects; Anti-Retroviral Agents - therapeutic use; Antitubercular agents; Antitubercular Agents - adverse effects; Antitubercular Agents - therapeutic use; Antiviral agents; CD4 Lymphocyte Count; Comorbidity; Cross-Sectional Studies; Female; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV patients; Humans; Immune reconstitution inflammatory syndrome; Immune Reconstitution Inflammatory Syndrome - chemically induced; Immune Reconstitution Inflammatory Syndrome - diagnosis; Immune Reconstitution Inflammatory Syndrome - epidemiology; Incidence; India - epidemiology; Male; Middle Aged; Risk Factors; Tuberculosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; India; Immune reconstitution inflammatory syndrome; Tuberculosis; HIV; CD4 lymphocyte count
• ISSN: 1413-8670; 1678-4391
• DOI: 10.1016/S1413-8670(11)70250-1

Tuberculosis is one of the leading causes of development of Immune reconstitution inflammatory syndrome (IRIS) in HIV patients receiving antiretroviral therapy (ART). To determine the incidence of IRIS in HIV-TB coinfected patients, and to find out the possible risk factors associated with IRIS. Study commenced with 96 patients adhered to standard antitubercular therapy (ATT) and ART without defaultering, and followed up for six months. The mean (± SD) CD4 count and CD4 percentage at baseline was 59.16 (± 24.63) per mm3 and 4.59% (± 1.73) respectively. Only 18.75% developed IRIS after 57.05 (± 14.12) days of initiation of ART. Extrapulmonary tuberculosis was the most significant factor associated with IRIS (83.33%) than those without IRIS (44.87%) (p=0.0032). Specifically, tubercular lymphadenitis (38.88%, p=0.0364) and disseminated tuberculosis (33.33%, p=0.0217) were significantly associated with IRIS. The other risk factors associated with appearance of IRIS were higher CD4 count (p=0.0212) at three months after initiation of ART and increment of CD4 count (p=0.0063) and CD4 percentage (p=0.0016) during this period. The major manifestations of IRIS were fever (40%), followed by lymphadenitis (38%). The mortality rate in IRIS was not higher than those without IRIS. Patients with extrapulmonary tuberculosis, especially tubercular lymphadenitis, were more likely to develop IRIS and fever was associated in most of them. Higher increment of CD4 count may indicate development of IRIS in presence of new or worsening tuberculosis lesion.