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Title: Clinical case definition and manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome
Authors: Weerawat Manosuthi
Hong Van Tieu
Wiroj Mankatitham
Aroon Lueangniyomkul
Jintanat Ananworanich
Anchalee Avihingsanon
Umaporn Siangphoe
Sukonsri Klongugkara
Sirirat Likanonsakul
Unchana Thawornwan
Bussakorn Suntisuklappon
Somnuek Sungkanuparph
Thailand Ministry of Public Health
Mahidol University
Columbia University, College of Physicians and Surgeons
The HIV Netherlands Australia Thailand Research Collaboration
South East Asia Research Collaboration with Hawaii
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Nov-2009
Citation: AIDS. Vol.23, No.18 (2009), 2467-2471
Abstract: BACKGROUND: The International Network for the Study of HIV-associated IRIS (INSHI) recently published criteria for tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) diagnosis. The performance of this definition and clinical manifestations of TB-IRIS were studied. METHODS: Antiretroviral therapy-naive HIV/TB Thai patients receiving antituberculous therapy were enrolled during 2006-2007 and prospectively followed through 24 weeks of antiretroviral therapy. Patients were defined as having paradoxical TB-IRIS if they fulfilled the 'study definition' by French 2004 and were confirmed by an external reviewer. All were later compared by the classification according to 'INSHI-2008'. RESULTS: For the 126 patients, median baseline CD4 cell count was 43 cells/μl and HIV-1 RNA was 5.9 log10 1̈ copies/ml. Seventy-three (58%) had extrapulmonary/disseminated TB. Twenty-two (18%) and 21 (17%) fulfilled TB-IRIS criteria according to the study definition and INSHI-2008 definition, respectively. Two (2%) were diagnosed by study definition only and one (1%) by INSHI-2008 definition only. Twenty (16%) were concordantly diagnosed by both definitions and 103 (82%) were consistently negative. Eighteen (82%) had worsening of a preexisting site, whereas four (18%) had TB-IRIS in a new location. Lymph node enlargement (73%) and fever (59%) were common in TB-IRIS. Sensitivity and specificity of INSHI-2008 was 91% (95% confidence interval, 72-98%) and 99% (95% confidence interval, 95-99.8%), respectively. Positive predictive value was 95% and negative predictive value was 98%. By multivariate analysis, factors predicting TB-IRIS were extrapulmonary TB (odds ratio, 8.63) and disseminated TB (odds ratio, 4.17). CONCLUSION: There was high concordance between the INSHI-2008 and French 2004 definition for TB-IRIS diagnosis in HIV/TB patients with relatively high rate of paradoxical TB-IRIS. This suggests that lack of HIV-1 RNA and CD4 cell count monitoring does not impede the ability to diagnose TB-IRIS. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
ISSN: 14735571
Appears in Collections:Scopus 2006-2010

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