Treatment for tuberculosis-associated immune reconstitution inflammatory syndrome in 34 HIV-infected patients
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: 2012-10-01
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