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Randomized Controlled Trial
. 2020 Sep:98:261-267.
doi: 10.1016/j.ijid.2020.06.097. Epub 2020 Jul 2.

Characteristics of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome and its influence on tuberculosis treatment outcomes in persons living with HIV

Gopalan Narendran  1 , Keerthana Jyotheeswaran  1 , Thirumaran Senguttuvan  1 , Caian L Vinhaes  2 , Ramesh K Santhanakrishnan  1 , Tamizhselvan Manoharan  1 , Anbhalagan Selvaraj  1 , Padmapriyadarsini Chandrasekaran  1 , Pradeep A Menon  1 , Kannabiran P Bhavani  1 , Devarajulu Reddy  1 , Ravichandran Narayanan  3 , Balaji Subramanyam  1 , Sekhar Sathyavelu  4 , Raja Krishnaraja  3 , Pownraj Kalirajan  1 , Dhanalakshmi Angamuthu  1 , Stella Mary Susaimuthu  1 , Ranjit R K Ganesan  5 , Srikanth P Tripathy  1 , Soumya Swaminathan  6 , Bruno B Andrade  7
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Free article
Randomized Controlled Trial

Characteristics of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome and its influence on tuberculosis treatment outcomes in persons living with HIV

Gopalan Narendran et al. Int J Infect Dis. 2020 Sep.
Free article

Abstract

Objective: The influence of tuberculosis (TB)-immune reconstitution inflammatory syndrome (IRIS) on TB treatment outcomes and its risk factors were investigated among people with human immunodeficiency virus (HIV) and co-infected with TB.

Methods: Newly diagnosed, culture-confirmed, pulmonary TB patients with HIV and enrolled in a clinical trial (NCT00933790) were retrospectively analysed for IRIS occurrence. Risk factors and TB outcomes (up to 18 months after initiation of anti-TB treatment [ATT]) were compared between people who experienced IRIS (IRIS group) and those who did not (non-IRIS group).

Results: TB-IRIS occurred in 82 of 292 (28%) participants. Significant baseline risk factors predisposing to TB-IRIS occurrence in univariate analysis were: lower CD4+ T-cell count, CD4/CD8 ratio, haemoglobin levels, presence of extra-pulmonary TB focus, and higher HIV viral load; the last two retained significance in the multivariate analysis. After 2 months of ATT commencement, sputum smear conversion was documented in 45 of 80 (56.2%) vs. 124 of 194 (63.9%) (p=0.23), culture conversion was in 75 of 80 (93.7%) vs. 178 of 194 (91.7%) (p=0.57) and the median decline in viral load (log10copies/mm3) was 2.7 in the IRIS vs. 1.1 in the non-IRIS groups (p<0.0001), respectively. An unfavourable response to TB therapy was detected in 17 of 82 (20.7%) and 28 of 210 (13.3%) in the IRIS and non-IRIS groups, respectively (p=0.14).

Conclusions: TB-IRIS frequently occurred in people with advanced HIV infection and in those who presented with extra-pulmonary TB lesions, without influencing subsequent TB treatment outcomes.

Keywords: Anti-TB treatment; Antiretroviral therapy; HIV; IRIS; Paradoxical reaction; Tuberculosis.

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