PMID- 19926965
OWN - NLM
STAT- MEDLINE
DCOM- 20101228
LR  - 20211020
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 24
IP  - 1
DP  - 2010 Jan 2
TI  - Validation of a published case definition for tuberculosis-associated immune 
      reconstitution inflammatory syndrome.
PG  - 103-8
LID - 10.1097/QAD.0b013e32832ec1f4 [doi]
AB  - OBJECTIVE: To evaluate the International Network for the Study of HIV-associated 
      IRIS (INSHI) case definitions for tuberculosis (TB)-associated immune 
      reconstitution inflammatory syndrome (IRIS) in a South African cohort. METHODS: 
      Prospective cohort of 498 adult HIV-infected patients initiating antiretroviral 
      therapy. Patients were followed up for 24 weeks and all clinical events were 
      recorded. Events with TB-IRIS as possible cause were assessed by consensus expert 
      opinion and INSHI case definition. Positive, negative, and chance-corrected 
      agreement (kappa) were calculated, and reasons for disagreement were assessed. 
      RESULTS: One hundred and two (20%) patients were receiving TB therapy at 
      antiretroviral therapy initiation. Three hundred and thirty-three events were 
      evaluated (74 potential paradoxical IRIS, 259 potential unmasking IRIS). Based on 
      expert opinion, there were 18 cases of paradoxical IRIS associated with TB and/or 
      other opportunistic disease. The INSHI criteria for TB-IRIS agreed in 13 
      paradoxical cases, giving positive agreement of 72.2%, negative agreement in 
      52/56 non-TB-IRIS events (92.9%), and kappa of 0.66. There were 19 unmasking 
      TB-IRIS cases based on expert opinion, of which 12 were considered IRIS using the 
      INSHI definition (positive agreement 63.2%). There was agreement in all 240 
      non-TB-IRIS events (negative agreement 100%) and kappa was 0.76. CONCLUSION: 
      There was good agreement between the INSHI case definition for both paradoxical 
      and unmasking TB-IRIS and consensus expert opinion. These results support the use 
      of this definition in clinical and research practice, with minor caveats in its 
      application.
FAU - Haddow, Lewis J
AU  - Haddow LJ
AD  - Division of Immunology, Infection and Inflammatory Disease, King's College 
      London, London, UK. lewis.haddow@kcl.ac.uk
FAU - Moosa, Mahomed-Yunus S
AU  - Moosa MY
FAU - Easterbrook, Philippa J
AU  - Easterbrook PJ
LA  - eng
GR  - G0200585/MRC_/Medical Research Council/United Kingdom
GR  - G0700530/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Validation Study
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
SB  - IM
MH  - Adult
MH  - Antiretroviral Therapy, Highly Active
MH  - Consensus
MH  - Female
MH  - HIV Infections/*complications/drug therapy/epidemiology
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*epidemiology
MH  - Male
MH  - Prospective Studies
MH  - Tuberculosis/*complications/drug therapy/epidemiology
EDAT- 2009/11/21 06:00
MHDA- 2010/12/29 06:00
CRDT- 2009/11/21 06:00
PHST- 2009/11/21 06:00 [entrez]
PHST- 2009/11/21 06:00 [pubmed]
PHST- 2010/12/29 06:00 [medline]
AID - 10.1097/QAD.0b013e32832ec1f4 [doi]
PST - ppublish
SO  - AIDS. 2010 Jan 2;24(1):103-8. doi: 10.1097/QAD.0b013e32832ec1f4.