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Original article

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, the TB-IRIS Study Group

Corresponding author name: William Worodria
Corresponding author e-mail: worodria@yahoo.com

Citation: Antiviral Therapy 2012; 17:841-848
doi: 10.3851/IMP2108

Date accepted: 10 October 2011
Date published online: 27 April 2012

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.

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