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Immune reconstitution syndrome in patients treated for HIV and tuberculosis in Rio de Janeiro.

AbstractWe made a retrospective longitudinal study from January 2000 to January 2003 to examine cases of immune reconstitution syndrome (IRS) and its incidence rate in tuberculosis (TB)-human immunodeficiency virus (HIV) co-infected patients. The incidence rate (IR) was calculated using a Poisson regression. The confidence interval (CI) that was stipulated was 95%. IRS occurred in 10/84 HIV and TB-positive patients; nine of them were on highly active anti-retroviral therapy (HAART) during a mean of 61.7 (+/- 59) days following the introduction of antiretrovirals. Lymph-node enlargement was the sole clinical manifestation. CD4 counts were <100 cells/mm(3)in 50% of the patients, at the time of TB diagnosis. All but two patients were treated with prednisone, and recovered from TB within a mean of 91 days (+/- 30 days). One relapse of TB was observed, but there were no IRS-related deaths. The incidence rate was higher (IR=11.18; CI, 1.41-88.76) in patients that had superficial lymph node enlargement at the moment of TB diagnosis (not associated with TB), extrapulmonary TB (IR=1.97; CI, 0.44-8.79), were antiretroviral naive (IR=1.85; CI, 0.48-7.16), and CD4 counts <100 cells/mm(3) (IR=1.50; CI, 0.40-5.59), although with a wide CI. IRS was frequent in our sample, occurred more frequently in HIV-naive patients with lymph-node enlargement and extrapulmonary TB. No cases of new pulmonary lesions or worsening of pulmonary infiltrates were observed.
AuthorsFabiana C Serra, David Hadad, Renata L Orofino, Flavia Marinho, Cristina Lourenço, Mariza Morgado, Valeria Rolla (Affiliation: Evandro Chagas Research Institute-Fiocruz, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, Brazil.)
JournalThe Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases (Braz J Infect Dis) Vol. 11 Issue 5 Pg. 462-5 (Oct 2007) ISSN: 1413-8670 Brazil
PMID17962870 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antitubercular Agents
Topics
  • AIDS-Related Opportunistic Infections (drug therapy, immunology)
  • Adult
  • Antiretroviral Therapy, Highly Active
  • Antitubercular Agents (therapeutic use)
  • Female
  • Humans
  • Immune Reconstitution Inflammatory Syndrome (immunology)
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Tuberculosis, Pulmonary (drug therapy, immunology)
  • Viral Load