Clinical spectrum, risk factors and outcome of immune reconstitution inflammatory syndrome in patients with tuberculosis-HIV coinfection

William Worodria, Joris Menten, Marguerite Massinga-Loembe, Doreen Mazakpwe, Danstan Bagenda, Olivier Koole, Harriet Mayanja-Kizza, Luc Kestens, Roy Mugerwa, Peter Reiss, Robert Colebunders

Research output: Contribution to journalArticle

24 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)841-848
Number of pages8
JournalAntiviral Therapy
Volume17
Issue number5
DOIs
StatePublished - Sep 10 2012

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Immune Reconstitution Inflammatory Syndrome
Coinfection
Tuberculosis
HIV
Logistic Models
Therapeutics
CD4 Lymphocyte Count

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Worodria, W., Menten, J., Massinga-Loembe, M., Mazakpwe, D., Bagenda, D., Koole, O., ... Colebunders, R. (2012). Clinical spectrum, risk factors and outcome of immune reconstitution inflammatory syndrome in patients with tuberculosis-HIV coinfection. Antiviral Therapy, 17(5), 841-848. https://doi.org/10.3851/IMP2108

Clinical spectrum, risk factors and outcome of immune reconstitution inflammatory syndrome in patients with tuberculosis-HIV coinfection. / Worodria, William; Menten, Joris; Massinga-Loembe, Marguerite; Mazakpwe, Doreen; Bagenda, Danstan; Koole, Olivier; Mayanja-Kizza, Harriet; Kestens, Luc; Mugerwa, Roy; Reiss, Peter; Colebunders, Robert.

In: Antiviral Therapy, Vol. 17, No. 5, 10.09.2012, p. 841-848.

Research output: Contribution to journalArticle

Worodria, W, Menten, J, Massinga-Loembe, M, Mazakpwe, D, Bagenda, D, Koole, O, Mayanja-Kizza, H, Kestens, L, Mugerwa, R, Reiss, P & Colebunders, R 2012, 'Clinical spectrum, risk factors and outcome of immune reconstitution inflammatory syndrome in patients with tuberculosis-HIV coinfection', Antiviral Therapy, vol. 17, no. 5, pp. 841-848. https://doi.org/10.3851/IMP2108
Worodria, William ; Menten, Joris ; Massinga-Loembe, Marguerite ; Mazakpwe, Doreen ; Bagenda, Danstan ; Koole, Olivier ; Mayanja-Kizza, Harriet ; Kestens, Luc ; Mugerwa, Roy ; Reiss, Peter ; Colebunders, Robert. / Clinical spectrum, risk factors and outcome of immune reconstitution inflammatory syndrome in patients with tuberculosis-HIV coinfection. In: Antiviral Therapy. 2012 ; Vol. 17, No. 5. pp. 841-848.
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AU - Massinga-Loembe, Marguerite

AU - Mazakpwe, Doreen

AU - Bagenda, Danstan

AU - Koole, Olivier

AU - Mayanja-Kizza, Harriet

AU - Kestens, Luc

AU - Mugerwa, Roy

AU - Reiss, Peter

AU - Colebunders, Robert

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N2 - 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.

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