Paradoxical Tuberculosis Immune Reconstitution Inflammatory Syndrome TB-IRIS in HIV Patients with Culture Confirmed Pulmonary Tuberculosis in India and the Potential Role of IL-6 in PredictionReport as inadecuate




Paradoxical Tuberculosis Immune Reconstitution Inflammatory Syndrome TB-IRIS in HIV Patients with Culture Confirmed Pulmonary Tuberculosis in India and the Potential Role of IL-6 in Prediction - Download this document for free, or read online. Document in PDF available to download.

Background

The incidence, manifestations, outcome and clinical predictors of paradoxical TB-IRIS in patients with HIV and culture confirmed pulmonary tuberculosis PTB in India have not been studied prospectively.

Methods

HIV+ patients with culture confirmed PTB started on anti-tuberculosis therapy ATT were followed prospectively after anti-retroviral therapy ART initiation. Established criteria for IRIS diagnosis were used including decline in plasma HIV RNA at IRIS event. Pre-ART plasma levels of interleukin IL-6 and C-reactive protein CRP were measured. Univariate and multivariate logistic regression models were used to evaluate associations between baseline variables and IRIS.

Results

Of 57 patients enrolled, 48 had complete follow up data. Median ATT-ART interval was 28 days interquartile range, IQR 14–47. IRIS events occurred in 26 patients 54.2% at a median of 11 days IQR: 7–16 after ART initiation. Corticosteroids were required for treatment of most IRIS events that resolved within a median of 13 days IQR: 9–23. Two patients died due to CNS TB-IRIS. Lower CD4+ T-cell counts, higher plasma HIV RNA levels, lower CD4-CD8 ratio, lower hemoglobin, shorter ATT to ART interval, extra-pulmonary or miliary TB and higher plasma IL-6 and CRP levels at baseline were associated with paradoxical TB-IRIS in the univariate analysis. Shorter ATT to ART interval, lower hemoglobin and higher IL-6 and CRP levels remained significant in the multivariate analysis.

Conclusion

Paradoxical TB–IRIS frequently complicates HIV-TB therapy in India. IL-6 and CRP may assist in predicting IRIS events and serve as potential targets for immune interventions.



Author: Gopalan Narendran , Bruno B. Andrade , Brian O. Porter, Chockalingam Chandrasekhar, Perumal Venkatesan, Pradeep A. Menon, Sudha S

Source: http://plos.srce.hr/



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