Tuberculosis (TB)-associated immune reconstitution inflammatory syndrome in TB-HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes

H. Tan, Y. Yong, S. Lim, S.A. Ponnampalavanar, S.F.S. Omar, Y. Pang, A.B. Kamarulzaman, Patricia Price, S.M. Crowe, Martyn French

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    4 Citations (Scopus)

    Abstract

    Background: Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important early complication of antiretroviral therapy (ART) in countries with high rates of endemic TB, but data from South-East Asia are incomplete. Identification of prevalence, risk factors and treatment outcomes of TB-IRIS in Malaysia was sought.

    Methods: A 3-year retrospective study was conducted among TB-HIV co-infected patients treated at the University of Malaya Medical Centre. Simple and adjusted logistic regressions were used to identify the predictors for TB-IRIS while Cox regression was used to assess the influence of TB-IRIS on long-term CD4 T-cell recovery.

    Results: One hundred and fifty-three TB-HIV patients were enrolled, of whom 106 had received both anti-TB treatment (ATT) and ART. The median (IQR) baseline CD4 T-cell count was 52 cells L-1 (13-130 cells L-1). Nine of 96 patients (9.4%) developed paradoxical TB-IRIS and eight developed unmasking TB-IRIS, at a median (IQR) time of 27 (12-64) and 19 (14-65) days, respectively. In adjusted logistic regression analysis, only disseminated TB was predictive of TB-IRIS [OR: 10.7 (95% CI: 1.2-94.3), P≤0.032]. Mortality rates were similar for TB-IRIS (n≤1, 5.9%) and non-TB-IRIS (n≤5, 5.7%) patients and CD4 T-cell recovery post-ART was not different between the two groups (P≤0.363).

    Conclusion: Disseminated TB was a strong independent predictor of TB-IRIS in Malaysian HIV-TB patients after commencing ART. This finding underscores the role of a high pathogen load in the pathogenesis of TB-IRIS; so interventions that reduce pathogen load before ART may benefit HIV patients with disseminated TB. © CSIRO 2014.
    Original languageEnglish
    Pages (from-to)532-539
    JournalSexual Health
    Volume11
    Issue number6
    DOIs
    Publication statusPublished - 9 Sep 2014

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