The immune reconstitution inflammatory syndrome with tuberculosis: A common problem in Ethiopian HIV-infected patients beginning antiretroviral therapy

Kedir Ali, Stephen A. Klotz

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

The Immune Reconstitution Inflammatory Syndrome (IRIS) in Ethiopian HIV-infected patients coinfected with tuberculosis (TB) was studied. HIV-infected outpatients initiating antiretroviral therapy (ART) at an HIV clinic in northern Ethiopia from January 2007 through September 2008 were identified (n = 1977). Patients with TB-IRIS occurring within 6 months of starting ART (n = 143) were compared with a control group of patients with HIV who began ART but did not develop TB-IRIS (n = 277). ART was not interrupted in any patient. Eleven (8%) patients with TB-IRIS died. New or "unmasked" TB with accompanying IRIS occurred in 132 or 92% of the cases. Worsening or "paradoxical" TB (ie, already known to be present and treated) was accompanied by IRIS in 11 (8%) patients. There was no significant difference between "unmasked" and "paradoxical" cases with respect to presentation of disease and outcome. Only a low baseline CD4 count (mean: 102 cells/μL) and a past history of World Health Organization (WHO) Clinical Stage 3 or 4 were associated with TB-IRIS (P <.05). The clinical manifestations of TB-IRIS were diverse, requiring a high index of suspicion. For example, pleural disease occurred in 13 patients, TB lymphadenitis in 17, intracranial TB in 9 patients, and disseminated TB in 15 patients. The majority of patients (88%) responded to continuation of ART and TB therapy. Thus, TB-IRIS is common in Ethiopian patients beginning ART, occurring in 7% of patients initiating antiretroviral therapy.

Original languageEnglish (US)
Pages (from-to)198-202
Number of pages5
JournalJournal of the International Association of Physicians in AIDS Care
Volume11
Issue number3
DOIs
StatePublished - May 1 2012

Keywords

  • Ethiopia
  • HIV/AIDS
  • IRIS
  • immune reconstitution
  • tuberculosis

ASJC Scopus subject areas

  • Immunology
  • Dermatology
  • Infectious Diseases

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