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- Open Access
Incidence of immune reconstitution inflammatory syndrome among HIV patients infected with tuberculosis in a Dublin cohort
© Muldoon et al; licensee BioMed Central Ltd. 2008
- Published: 10 November 2008
- Immune Reconstitution Inflammatory Syndrome
- Extrapulmonary Tuberculosis
- Peritoneal Tuberculosis
Globally, the incidence of HIV-associated tuberculosis (TB) infection is increasing. In this regard TB-associated immune reconstitution inflammatory syndrome (IRIS) after initiation of antiretroviral therapy is well recognised with rates as high as 45% being reported. The aim of this study was to review the clinical presentation of patients with TB/HIV co-infection and the incidence of IRIS in a large academic medical centre in Dublin.
A retrospective chart review was conducted on HIV-positive patients diagnosed with TB between December 2003 and May 2008. All patients were HIV positive and had a confirmed mycobacterial tuberculosis diagnosis, or a clinically presumptive diagnosis with response to anti-tuberculosis therapy. Data collected included patient demographics, clinical presentation, baseline CD4 counts and the development of a clinical syndrome consistent with IRIS.
Of the 30 charts reviewed, 18 (60%) were female and 12 (40%) were male. Seven patients (23%) were European (six Irish and one British) while the remainder of the patients were from sub-Saharan Africa or south-east Asia. Thirteen (43%) had pulmonary disease, the remainder (17 patients) presented with extra-pulmonary disease and of these, eight (27%) had disseminated disease. Five (17%) presented with lymphadenitis, three (10%) with cerebral TB or meningitis and one (3%) patient with peritoneal tuberculosis. One patient had multi-drug resistant tuberculosis and another had streptomycin resistance. At the time of their TB diagnosis, 18 (60%) had a CD4 count of less than 200 and 22 (73%) were antiretroviral therapy (ART) naïve. Eleven (37%) had a baseline HIV viral load greater than 100,000 copies/ml. Four (13%) patients had a clinical syndrome consistent with IRIS following initiation of their anti-TB therapy, all of whom had a CD4 count less than 100. Three of the patients presented with high grade temperatures and one presented with worsening lymphadenopathy. ART was initiated at a median duration of 8 weeks after TB treatment; one patient did not receive ART during their TB therapy. Two patients had disseminated disease, one extra-pulmonary disease and one pulmonary disease.
HIV/TB co-infection is more prevalent in the immigrant population. Our rate of IRIS is 13% in patients co-infected with HIV/TB, which is lower than previous series. The development of IRIS depends on the population studied, but extrapulmonary tuberculosis and low CD4 counts appear to be risk factors for IRIS.
This article is published under license to BioMed Central Ltd.