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. Author manuscript; available in PMC: 2010 Jan 10.
Published in final edited form as: Lancet Infect Dis. 2008 Aug;8(8):516–523. doi: 10.1016/S1473-3099(08)70184-1

Table.

Paradoxical tuberculosis-associated IRIS: cohort studies reported in the literature*

Country Number of patients on
tuberculosis treatment
starting ART
Number of patients with
paradoxical tuberculosis-
associated IRIS
Interval from
initation of ART to
IRIS presentation
Risk factors for tuberculosis-associated
IRIS
Narita et al (1998)22 USA 33 12 (36%) Mean 15 days
(SD 11 days)
Purified protein derivative conversion
Breen et al (2004)23 UK 28 8 (29%) Median 11 days
(range 8–18 days)
Starting ART within 6 weeks of
tuberculosis diagnosis
Breton et al
(2004)24
France 37 16 (43%) Median 12 days
(range 2–114 days)
Greater increase in CD4 percentage and
CD4/CD8 ratio; disseminated tuberculosis
Kumarasamy et al
(2004)8
India 144 11 (8%) Median 42 days
(range 10–89 days)
··
Shelburne et al
(2005)21
USA 86 26 (30%) Median 46 days
(range 3–658 days)
Shorter interval to starting ART; more
rapid initial fall in viral load
Michailidis et al
(2005)25
UK 28 9 (32%) Median 0·6 months
(IQR 0·1–9·1 months)
Lower baseline CD4 cell count;
disseminated tuberculosis; greater CD4
rise on ART
Manosuthi et al
(2006)9
Thailand 167 21 (13%) Median 32 days
(IQR 14–115 days)
Extrapulmonary tuberculosis
Lawn et al (2007)10 South
Africa
160 19 (12%) Median 2 weeks
(IQR 1·5–3·5 weeks)
Lower baseline CD4 cell count; shorter
interval to starting ART
Burman et al
(2007)26
USA 109 19 (17%) Median 34 days
(IQR 8–97 days)
Black ethnic origin; shorter interval to
starting ART; extrapulmonary tuberculosis
··

=not reported. ART=antiretroviral therapy. IRIS=immune reconstitution infl ammatory syndrome.

*

Only studies where more than eight patients with paradoxical tuberculosisassociated IRIS were reported are included. This table is an updated version of a previously published table. 27 Studies are presented in chronological order.

The authors reported 57 cases of tuberculosis, Mycobacterium avium complex, and cryptococcal IRIS (26 of 57 were tuberculosis-associated IRIS). Five of these 57 patients started ART before the opportunistic infection was diagnosed, and were thus not paradoxical IRIS cases. The data shown regarding risk factors and median interval relate to all 57 patients.

14 tuberculosis-associated IRIS cases were reported. Nine of these were paradoxical tuberculosis-associated IRIS cases. Data shown regarding risk factors relate to all 14 cases.

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