Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors

Simple item page
dc.contributor.authorBana, Tasnim M
dc.contributor.authorLesosky, Maia
dc.contributor.authorPepper, Dominique J
dc.contributor.authorvan der Plas, Helen
dc.contributor.authorSchutz, Charlotte
dc.contributor.authorGoliath, Rene
dc.contributor.authorMorroni, Chelsea
dc.contributor.authorMendelson, Marc
dc.contributor.authorMaartens, Gary
dc.contributor.authorWilkinson, Robert J
dc.contributor.authorMeintjes, Graeme
dc.date.accessioned2016-10-27T12:09:18Z
dc.date.available2016-10-27T12:09:18Z
dc.date.issued2016-09-27
dc.date.updated2016-09-27T18:04:06Z
dc.description.abstractBackground: In a proportion of patients with HIV-associated tuberculosis who develop paradoxical immune reconstitution inflammatory syndrome (IRIS), the clinical course of IRIS is prolonged necessitating substantial health care utilization for diagnostic and therapeutic interventions. Prolonged TB-IRIS has not been prospectively studied to date. We aimed to determine the proportion of patients with prolonged TB-IRIS, as well as the clinical characteristics and risk factors for prolonged TB-IRIS. Methods: We pooled data from two prospective observational studies and a randomized controlled trial conducted in Cape Town, South Africa, that enrolled patients with paradoxical TB-IRIS. We used the same diagnostic approach and clinical case definitions for TB-IRIS in the 3 studies. Prolonged TB-IRIS was defined as TB-IRIS symptoms lasting > 90 days. Risk factors for prolonged TB-IRIS were analysed using Wilcoxon rank sum test, Fisher’s exact test, multivariate logistic regression and Cox proportional hazards models. Results: Two-hundred and sixteen patients with TB-IRIS were included. The median duration of TB-IRIS symptoms was 71.0 days (IQR 41.0–113.2). In 73/181 patients (40.3 %) with adequate follow-up data, IRIS duration was > 90 days. Six patients (3.3 %), mainly with lymph node involvement, had IRIS duration > 1 year. In univariate logistic regression analysis the following were significantly associated with IRIS duration > 90 days: lymph node involvement at initial TB diagnosis, drug-resistant TB, lymph node TB-IRIS, and not being hospitalised at time of TB-IRIS diagnosis. In our multivariate logistic regression model lymph node TB-IRIS (aOR 2.27, 95 % CI 1.13–4.59) and not being hospitalised at time of TB-IRIS diagnosis (aOR for being hospitalised 0.5, 95 % CI 0.25-0.99) remained significantly associated with prolonged TB-IRIS, and drug-resistant TB was of borderline significance (aOR 3.26, 95 % CI 0.97–12.99). The association of not being hospitalised with longer duration of IRIS might be related to 1 of the 3 cohorts in which all patients were hospitalised at ART initiation with close inpatient follow-up. This could have resulted in diagnosis of milder cases and earlier IRIS treatment potentially resulting in shorter TB-IRIS duration in these hospitalised patients. Conclusions: Around 40 % of patients with TB-IRIS have symptoms for more than 90 days. Involvement of lymph nodes at time of TB-IRIS is an independent risk factor for prolonged TB-IRIS. Future studies should address whether more prompt anti-inflammatory treatment of lymph node TB-IRIS reduces the risk of prolonged TB-IRIS. Trial registration: The randomized controlled trial was registered with Current Controlled Trials ISRCTN21322548 on 17 August 2005.en_ZA
dc.identifier.apacitationBana, T. M., Lesosky, M., Pepper, D. J., van der Plas, H., Schutz, C., Goliath, R., ... Meintjes, G. (2016). Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/22326en_ZA
dc.identifier.chicagocitationBana, Tasnim M, Maia Lesosky, Dominique J Pepper, Helen van der Plas, Charlotte Schutz, Rene Goliath, Chelsea Morroni, et al "Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors." <i>BMC Infectious Diseases</i> (2016) http://hdl.handle.net/11427/22326en_ZA
dc.identifier.citationBana, T. M., Lesosky, M., Pepper, D. J., van der Plas, H., Schutz, C., Goliath, R., ... & Meintjes, G. (2016). Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors. BMC Infectious Diseases, 16(1), 518.en_ZA
dc.identifier.issn1471-2334en_ZA
dc.identifier.ris TY - Journal Article AU - Bana, Tasnim M AU - Lesosky, Maia AU - Pepper, Dominique J AU - van der Plas, Helen AU - Schutz, Charlotte AU - Goliath, Rene AU - Morroni, Chelsea AU - Mendelson, Marc AU - Maartens, Gary AU - Wilkinson, Robert J AU - Meintjes, Graeme AB - Background: In a proportion of patients with HIV-associated tuberculosis who develop paradoxical immune reconstitution inflammatory syndrome (IRIS), the clinical course of IRIS is prolonged necessitating substantial health care utilization for diagnostic and therapeutic interventions. Prolonged TB-IRIS has not been prospectively studied to date. We aimed to determine the proportion of patients with prolonged TB-IRIS, as well as the clinical characteristics and risk factors for prolonged TB-IRIS. Methods: We pooled data from two prospective observational studies and a randomized controlled trial conducted in Cape Town, South Africa, that enrolled patients with paradoxical TB-IRIS. We used the same diagnostic approach and clinical case definitions for TB-IRIS in the 3 studies. Prolonged TB-IRIS was defined as TB-IRIS symptoms lasting > 90 days. Risk factors for prolonged TB-IRIS were analysed using Wilcoxon rank sum test, Fisher’s exact test, multivariate logistic regression and Cox proportional hazards models. Results: Two-hundred and sixteen patients with TB-IRIS were included. The median duration of TB-IRIS symptoms was 71.0 days (IQR 41.0–113.2). In 73/181 patients (40.3 %) with adequate follow-up data, IRIS duration was > 90 days. Six patients (3.3 %), mainly with lymph node involvement, had IRIS duration > 1 year. In univariate logistic regression analysis the following were significantly associated with IRIS duration > 90 days: lymph node involvement at initial TB diagnosis, drug-resistant TB, lymph node TB-IRIS, and not being hospitalised at time of TB-IRIS diagnosis. In our multivariate logistic regression model lymph node TB-IRIS (aOR 2.27, 95 % CI 1.13–4.59) and not being hospitalised at time of TB-IRIS diagnosis (aOR for being hospitalised 0.5, 95 % CI 0.25-0.99) remained significantly associated with prolonged TB-IRIS, and drug-resistant TB was of borderline significance (aOR 3.26, 95 % CI 0.97–12.99). The association of not being hospitalised with longer duration of IRIS might be related to 1 of the 3 cohorts in which all patients were hospitalised at ART initiation with close inpatient follow-up. This could have resulted in diagnosis of milder cases and earlier IRIS treatment potentially resulting in shorter TB-IRIS duration in these hospitalised patients. Conclusions: Around 40 % of patients with TB-IRIS have symptoms for more than 90 days. Involvement of lymph nodes at time of TB-IRIS is an independent risk factor for prolonged TB-IRIS. Future studies should address whether more prompt anti-inflammatory treatment of lymph node TB-IRIS reduces the risk of prolonged TB-IRIS. Trial registration: The randomized controlled trial was registered with Current Controlled Trials ISRCTN21322548 on 17 August 2005. DA - 2016-09-27 DB - OpenUCT DO - 10.1186/s12879-016-1850-2 DP - University of Cape Town J1 - BMC Infectious Diseases KW - Tuberculosis KW - HIV KW - Immune reconstitution inflammatory syndrome KW - IRIS KW - Glucocorticoids LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 SM - 1471-2334 T1 - Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors TI - Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors UR - http://hdl.handle.net/11427/22326 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1186/s12879-016-1850-2
dc.identifier.urihttp://hdl.handle.net/11427/22326
dc.identifier.vancouvercitationBana TM, Lesosky M, Pepper DJ, van der Plas H, Schutz C, Goliath R, et al. Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors. BMC Infectious Diseases. 2016; http://hdl.handle.net/11427/22326.en_ZA
dc.languageengen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.publisher.departmentDivision of Infectious Disease and HIV Meden_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsCreative Commons Attribution 4.0 International (CC BY 4.0)*
dc.rights.holderThe Author(s).
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://bmcinfectdis.biomedcentral.com/
dc.subjectTuberculosis
dc.subjectHIV
dc.subjectImmune reconstitution inflammatory syndrome
dc.subjectIRIS
dc.subjectGlucocorticoids
dc.titleProlonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factorsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetype
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
12879_2016_Article_1850.pdf
Size:
615.24 KB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
1.72 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Journal Articles