Evaluation of paradoxical TB-associated IRIS with the use of standardized case definitions for resource-limited settings
Ingrid Eshun-Wilson, Fiona Havers, Jean B Nachega, Hans W Prozesky, Jantjie J Taljaard, Michele D Zeier, Mark Cotton, Gary Simon, Patrick Soentjens, Ingrid Eshun-Wilson, Fiona Havers, Jean B Nachega, Hans W Prozesky, Jantjie J Taljaard, Michele D Zeier, Mark Cotton, Gary Simon, Patrick Soentjens
Abstract
Objective: Standardized case definitions have recently been proposed by the International Network for the Study of HIV-associated immune reconstitution inflammatory syndrome (INSHI; [IRIS]) for use in resource-limited settings. We evaluated paradoxical tuberculosis (TB)-associated IRIS in a large cohort from a TB endemic setting with the use of these case definitions.
Design: A retrospective cohort study.
Method: We reviewed records from 1250 South African patients who initiated antiretroviral therapy (ART) over a 5-year period.
Results: A total of 333 (27%) of the patients in the cohort had prevalent TB at the initiation of ART. Of 54 possible paradoxical TB-associated IRIS cases, 35 fulfilled the INSHI case definitions (11% of TB cases).
Conclusions: INSHI-standardized case definitions were used successfully in identifying paradoxical TB-associated IRIS in this cohort and resulted in a similar proportion of TB IRIS cases (11%) as that reported in previous studies from resource-limited settings (8%-13%). This case definition should be evaluated prospectively.
Source: PubMed