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

Abstract

examine cases of immune reconstitution syndrome (IRS) and its incidence rate in tuberculosis (TB)-human immunodeficiency virus (HIV) coinfected 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.

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

“…of patients with HIV-TB coinfection develop IRD (11,13,15,71,77,102,104,128,129,149), beginning as early as 5 days after starting ART (116). Most patients develop symptoms within the first 2 to 6 weeks (71,77,104,128,129), though cases may occur after 1 to 4 years (58,62,129).…”

“…Most patients develop symptoms within the first 2 to 6 weeks (71,77,104,128,129), though cases may occur after 1 to 4 years (58,62,129).…”

“…1). Two studies describe TB-IRD in lymph nodes alone (71,128), while several studies show diverse manifestations (11,13,15,61,77,99,102,129). Pulmonary and intra-abdominal diseases are common (13,15,77,129).…”

Immune reconstitution disease associated with mycobacterial infections

“…More recently studies from India [16], Thailand [17], South Africa [18 ] and Brazil [19 ] have been published. These studies found substantially lower rates of TB IRD with 8, 13, 12 and 12% of patients, respectively, being affected.…”

“…These rates include the predominance of localized (paucibacillary) lymph node disease [16,19 ], comparatively high baseline CD4 cell counts [16], or delayed initiation of ART [17,18 ,19 ]. The timing of ART has a particularly important impact on risk of IRD (Fig.…”