Treatment for tuberculosis-associated immune reconstitution inflammatory syndrome in 34 HIV-infected patients
Abstract:BACKGROUND: Paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) frequently follows the initiation of antiretroviral therapy (ART) in patients with tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection. Treatment recommendations are nearly exclusively based on expert opinion.
OBJECTIVE: To assess the clinical outcomes of patients treated using various strategies for TB-IRIS.
METHODS: In a retrospective analysis of patients treated in Paris hospitals from 1996 to 2008, we describe TB-IRIS outcome, frequency of relapses and CD4 cell count changes after 12 months of ART for the following strategies: no treatment, interrupted ART and use of steroids.
RESULT: Among 34 patients, TB-IRIS outcome was favourable in 10/10 with no treatment, 11/13 with ART interruption, 3/3 with ART interruption and simultaneous use of steroids and 8/8 with steroids alone. Relapses were observed in both the ART interruption (6/13, 46%) and steroids (4/8, 50%) groups, but were less frequent in the no-treatment group (1/10, 10%). Steroids were prescribed in 61% of the patients and had no significant side effects; steroid use was associated with a trend towards a lower median CD4 cell count at 12 months of ART compared to the others (230 vs. 322 cells/mm3), despite no baseline differences.
CONCLUSION: TB-IRIS outcome was favourable regardless of the therapeutic strategies employed. Although steroids were widely used and well-tolerated, an initial wait-and-see attitude in the case of non-severe IRIS remains an interesting strategy to be evaluated.
Document Type: Research Article
Affiliations: 1: Department of Internal Medicine, Paris VI University, Hôpital Pitié-Salpêtrière, Paris, France 2: Department of Internal Medicine, Hôpital Hautepierre, Strasbourg, France 3: Department of Rhumatology, Hôpital Bicètre, Kremlin-Bicêtre, France 4: Department of Pneumology, Centre Hospitalier de la Côte Basque, Bayonne, France; and Department of Infectious and Tropical Diseases, Hôpital Bichat, Paris, France 5: Department of Internal Medicine and Clinical Immunology, Hôpital Béclère, Clamart, France 6: Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d'Investigation Clinique 007 Bichat, INSERM U 738, Hôpital Bichat, Paris, France 7: Department of Infectious and Tropical Diseases, Hôpital Bichat, Paris, France 8: Department of Infectious and Tropical Diseases, Hôpital Avicenne, Bobigny, France 9: Unité Mixte de Recherche-S738, Institut National de la Santé et de la Recherche Médicale, Paris Diderot Paris 7 University, Centre Hospitalière Universitaire X-Bichat, Paris, France; and Epidemic and Biological Risk Coordination Unit, Assistance Publique–Hôpitaux de Paris, Paris, France
Publication date: October 1, 2012
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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