Tuberculosis-associated immune reconstitution inflammatory syndrome in patients living with HIV-1: a 15- years retrospective cohort study.

Background

The initiation of antiretroviral therapy (ART) in people co-infected with HIV and tuberculosis (TB) may trigger tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS), a condition associated with a significant morbidity and mortality

Methods

We conducted a retrospective study of patients co-infected with HIV and TB over 15 years, with the aim to describe the clinical characteristics of patients who developed TB-IRIS and to identify factors predictive of its occurrence.

Results

Overall, 28 of the 123 patients (22.8%) developed TB-IRIS, including 18 cases of paradoxical TB-IRIS among 89 patients at risk (20.2%) and 10 cases of unmasking TB-IRIS among 34 patients at risk (29.4%). The most frequent TB sites were lymph nodes (n=17, 61%), the central nervous system (CNS) (n=5, 18%) and lungs (n=5, 18%). Corticosteroids were administered to 9 patients (32%). Eight deaths (29%) occurred in patients with TB-IRIS. In univariate analysis, factors associated with paradoxical TB-IRIS included CNS TB (p=0.032), higher white blood cell count (p=0.045), and negative Toxoplasma serology (p=0.032). Among patients at risk of unmasking TB-IRIS, factors associated with the occurrence of unmasking TB-IRIS included the absence of TB chemoprophylaxis (p=0.017), female sex (p=0.048), and hematopoietic-organ involvement of TB (p=0.020).

Conclusion

TB-IRIS is a severe complication in people living with HIV and is becoming increasingly frequent. Early identification of risk factors is essential to prevent its occurrence and to reduce associated mortality.