PMID- 20549841
OWN - NLM
STAT- MEDLINE
DCOM- 20110113
LR  - 20190718
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 24
IP  - 10
DP  - 2010 Jun 19
TI  - Risk factors for 'unmasking immune reconstitution inflammatory syndrome' 
      presentation of tuberculosis following combination antiretroviral therapy 
      initiation in HIV-infected patients.
PG  - 1519-25
AB  - OBJECTIVE: To determine characteristics and risk factors for unmasking 
      tuberculosis (TB)-associated immune reconstitution inflammatory syndrome (IRIS) 
      following initiation of combination antiretroviral therapy (cART) in HIV-infected 
      patients, which have not yet been assessed to date. DESIGN: Retrospective 
      single-center cohort study. METHODS: Medical records of HIV-infected patients 
      diagnosed with tuberculosis following cART initiation were reviewed. Cases of 
      unmasking IRIS were identified using provisional consensus definitions. 
      Characteristics of patients with and without unmasking TB-IRIS were compared. A 
      case-control design was used to identify risk factors for unmasking TB-IRIS in 
      patients initiating cART. RESULTS: Among 47 patients on cART at TB diagnosis, 11 
      experienced unmasking IRIS (23%). They had lower CD4% (9 vs. 14, P=0.02), higher 
      HIV-RNA load at baseline (5.2 vs. 4.0 log, P=0.005), and a stronger CD4% increase 
      with HIV-RNA decline after 1 month on cART (+7 vs. +3 log, P=0.02, and -3.2 vs. 
      -0.8 log, P=0.005) than the 36 remaining patients without unmasking IRIS. In the 
      case-control study, risk factors for unmasking IRIS were African country of 
      origin (65 vs. 18%, P=0.007), higher baseline HIV-RNA load (5.2 vs. 4.7 log, 
      P=0.01), stronger CD4% increase (+7 vs. +2, P=0.0001), and HIV-RNA decline of 
      more than 3 log after 1 month on cART (73 vs. 27%, P=0.02). CONCLUSION: Patients 
      with African origins, advanced HIV infection, or a strong response to cART are at 
      greater risk of unmasking TB-IRIS.
FAU - Valin, Nadia
AU  - Valin N
AD  - Service des Maladies Infectieuses et Tropicales, Hopital Saint-Antoine, 
      Assistance Publique-Hopitaux de Paris, Paris, France. nadia.valin@sat.aphp.fr
FAU - Pacanowski, Jerome
AU  - Pacanowski J
FAU - Denoeud, Lise
AU  - Denoeud L
FAU - Lacombe, Karine
AU  - Lacombe K
FAU - Lalande, Valerie
AU  - Lalande V
FAU - Fonquernie, Laurent
AU  - Fonquernie L
FAU - Girard, Pierre-Marie
AU  - Girard PM
FAU - Meynard, Jean-Luc
AU  - Meynard JL
LA  - eng
PT  - Journal Article
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
SB  - IM
MH  - AIDS-Related Opportunistic Infections/drug therapy/immunology
MH  - *Antiretroviral Therapy, Highly Active
MH  - CD4 Lymphocyte Count
MH  - Case-Control Studies
MH  - Female
MH  - HIV Infections/*drug therapy/immunology
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*diagnosis/etiology/immunology
MH  - Male
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Tuberculosis/diagnosis/*immunology
EDAT- 2010/06/16 06:00
MHDA- 2011/01/14 06:00
CRDT- 2010/06/16 06:00
PHST- 2010/06/16 06:00 [entrez]
PHST- 2010/06/16 06:00 [pubmed]
PHST- 2011/01/14 06:00 [medline]
AID - 10.1097/qad.0b013e3283396007 [doi]
PST - ppublish
SO  - AIDS. 2010 Jun 19;24(10):1519-25. doi: 10.1097/qad.0b013e3283396007.