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.