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. 2008 Sep;8(3):190-5.

Worsening and unmasking of tuberculosis in HIV-1 infected patients after initiating highly active anti-retroviral therapy in Uganda

Joshua Baalwa  1 , Harriet Mayanja-Kizza, Moses R Kamya, Laurence John, Andrew Kambugu, Robert Colebunders
Affiliations

Worsening and unmasking of tuberculosis in HIV-1 infected patients after initiating highly active anti-retroviral therapy in Uganda

Joshua Baalwa et al. Afr Health Sci. 2008 Sep.

Abstract

Objectives: To determine the proportion of patients developing active tuberculosis (TB) versus that of patients who experience worsening of TB, after initiating highly active anti retroviral therapy (HAART).

Methods: Charts of HAART naïve patients with or without clinically active TB who consecutively commenced HAART at Mulago Hospital Infectious Diseases Institute were reviewed. Patients were assessed for worsening of TB on treatment or development of new active TB (unmasking of TB) after initiating HAART.

Results: Of 271 patients without active TB at baseline who initiated HAART, 16 (5.9%) developed active TB within 6 months (early unmasking) and 10 (2.7%) after 6 months (late unmasking). Seven of 10 late unmasking patients had a past history of treatment for a TB disease episode. Of 45 patients who commenced HAART with coexisting active TB, 13 (29%) experienced worsening of TB symptoms, signs and/or radiological features. Nine of these 45 commenced HAART during the intensive phase of TB treatment, of whom 2 (22%) experienced worsening of TB. Thirty six of 45 started HAART during the continuation phase of TB treatment of whom 11 (31%), experienced worsening of TB. The median time from initiation of HAART to worsening of TB in patients on concurrent active TB treatment was 5 weeks, and 18 weeks to unmasking of new active tuberculosis.

Conclusion: Unmasking of TB was commonest in the first 6 months of HAART and declined in the subsequent months with most in the late unmasking group being TB recurrences. Worsening of TB occurred even after HAART was delayed to the continuation phase of TB treatment.

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Figures

Figure 1
Figure 1
Bi-modal peak of TB unmasking after initiation of HAART
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References

    1. Badri M, Wilson D, Wood R. Effect of HAART on the incidence of TB in South Africa: a cohort study. Lancet. 2002;359(9323):2059–2064. - PubMed
    1. Jones JL, Hanson DL, Dworkin MS, DeCock KM. HIV-associated TB in the era of HAART The Adult/Adolescent Spectrum of HIV Disease Group. Int J Tuberc Lung Dis. 2000;4(11):1026–1031. - PubMed
    1. Santoro-Lopes G, de Pinho AM, Harrison LH, Schechter M. Reduced risk of TB among Brazilian patients with advanced HIV infection treated with HAART. Clin Infect dis. 2002;34(4):543–546. - PubMed
    1. Dean GL, Edwards SG, Ives NJ, et al. Treatment of tuberculosis in HIV-infected persons in the era of highly active antiretroviral therapy. AIDS. 2002;16(11):1569–1570. - PubMed
    1. Narita M, Ashkin D, Hollender ES, Pitchenik AE. Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS. Am J Respir Crit Care Med. 1998;158(1):157–161. - PubMed

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