Frequency, severity and duration of immune reconstitution events in HIV-related tuberculosis.

Abstract

SETTING:

Patients were enrolled in a prospective trial of rifabutin-based tuberculosis (TB) treatment for human immunodeficiency virus related TB. Antiretroviral therapy (ART) was encouraged, but not required.

OBJECTIVE:

To evaluate the frequency, risk factors and duration of immune reconstitution events.

DESIGN:

Patients were prospectively evaluated for immune reconstitution events, and all adverse event reports were reviewed to identify possible unrecognized events.

RESULTS:

Of 169 patients, 25 (15%) developed immune reconstitution events related to TB. All 25 were among the 137 patients who received ART during TB treatment, so the frequency in this subgroup was 18% (25/137). Risk factors for an immune reconstitution event in multivariate analysis were Black race, the presence of extra-pulmonary TB and a shorter interval from initiation of TB treatment to initiation of ART. The most common clinical manifestations were fever (64%), new or worsening adenopathy (52%) and worsening pulmonary infiltrates (40%). Twelve patients (48%) were hospitalized for a median of 7 days, six underwent surgery and 11 had needle aspiration. The median duration of events was 60 days (range 11-442).

CONCLUSION:

Immune reconstitution events were common among patients receiving ART during TB treatment, produced substantial morbidity and had a median duration of 2 months.

• Authors: W Burman, S Weis, A Vernon, A Khan, D Benator, B Jones, C Silva, B King, C LaHart, B Mangura, M Weiner, W El-Sadr
• Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Int J Tuberc Lung Dis) Vol. 11 Issue 12 Pg. 1282-9 (Dec 2007) ISSN: 1027-3719 [Print] France
• PMID: 18229435 (Publication Type: Journal Article)

Chemical References

• Antitubercular Agents
• Rifabutin

Topics

• AIDS-Related Opportunistic Infections (drug therapy, immunology)
• Adult
• Antiretroviral Therapy, Highly Active (adverse effects)
• Antitubercular Agents (adverse effects, therapeutic use)
• Chi-Square Distribution
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Prospective Studies
• Rifabutin (adverse effects, therapeutic use)
• Risk Factors
• Severity of Illness Index
• Treatment Outcome
• Tuberculosis (drug therapy, immunology)