PMID- 24226057
OWN - NLM
STAT- MEDLINE
DCOM- 20140421
LR  - 20211021
IS  - 1944-7884 (Electronic)
IS  - 1525-4135 (Print)
IS  - 1525-4135 (Linking)
VI  - 65
IP  - 4
DP  - 2014 Apr 1
TI  - Tuberculosis immune reconstitution inflammatory syndrome in A5221 STRIDE: timing, 
      severity, and implications for HIV-TB programs.
PG  - 423-8
LID - 10.1097/QAI.0000000000000030 [doi]
AB  - RATIONALE AND OBJECTIVES: Earlier initiation of antiretroviral therapy (ART) in 
      HIV-tuberculosis (TB) is associated with increased immune reconstitution 
      inflammatory syndrome (IRIS). The severity, frequency, and complications of TB 
      IRIS were evaluated in A5221, a randomized trial of earlier ART (within 2 weeks 
      after TB treatment initiation) vs. later ART (8-12 weeks after TB treatment) in 
      HIV-infected patients starting TB treatment. METHODS AND MEASUREMENTS: In 806 
      participants, TB IRIS was defined using published clinical criteria. Cases were 
      classified as severe (hospitalization/death), moderate (corticosteroid 
      use/invasive procedure), or mild (no hospitalization/procedures/steroids). Fisher 
      exact, Wilcoxon, and log-rank tests were used for comparisons. MAIN RESULTS: TB 
      IRIS occurred in 61 (7.6%) patients: 10.4% in earlier vs. 4.7% in later ART, 
      11.5% with CD4 <50 vs. 5.4% with CD4 >/=50 cells per cubic millimeter. The CD4/ART 
      arm interaction was significant, P = 0.014, with 44.3% of TB IRIS occurring with 
      CD4 <50 and earlier ART. TB IRIS occurred sooner with earlier vs. later ART 
      initiation, at a median of 29 vs. 82 days after TB treatment initiation (P < 
      0.001). IRIS manifestations included lymphadenopathy (59.0%), constitutional 
      symptoms (54.1%), and radiographic changes (41.0%); central nervous system TB 
      IRIS was uncommon (6.6%). TB IRIS was mild in 27.9%, moderate in 41.0%, and 
      severe in 31.1%. No TB IRIS-associated deaths occurred. IRIS management required 
      >/=1 invasive procedures in 34.4%, hospitalization in 31.1%, and corticosteroids in 
      54.1%. CONCLUSIONS: TB IRIS was more frequent with earlier ART initiation and CD4 
      <50 cells per cubic millimeter. As ART is implemented earlier in HIV-TB 
      coinfection, programs will require the diagnostic capabilities, clinical 
      resources, and training necessary to manage TB IRIS.
FAU - Luetkemeyer, Anne F
AU  - Luetkemeyer AF
AD  - *HIV/AIDS Division, San Francisco General Hospital, University of California, San 
      Francisco, CA; daggerCenter for Biostatistics in AIDS Research, Harvard School of 
      Public Health, Boston, MA; double daggerDepartment of Medicine, College of Medicine, 
      Blantyre, Malawi;  section signFaculty of Heath Sciences, University of the Witwatersrand, 
      Johannesburg, South Africa;  ||Division of Infectious Diseases, School of Medicine, 
      University of California, San Diego, CA; and  paragraph signDivision of Infectious Diseases, 
      University of Nebraska Medical Center, Omaha, NE.
FAU - Kendall, Michelle A
AU  - Kendall MA
FAU - Nyirenda, Mulinda
AU  - Nyirenda M
FAU - Wu, Xingye
AU  - Wu X
FAU - Ive, Prudence
AU  - Ive P
FAU - Benson, Constance A
AU  - Benson CA
FAU - Andersen, Janet W
AU  - Andersen JW
FAU - Swindells, Susan
AU  - Swindells S
FAU - Sanne, Ian M
AU  - Sanne IM
FAU - Havlir, Diane V
AU  - Havlir DV
FAU - Kumwenda, Johnstone
AU  - Kumwenda J
CN  - Adult AIDS Clinical Trials Group A5221 Study Team
LA  - eng
GR  - UM1 AI069456/AI/NIAID NIH HHS/United States
GR  - UM1 AI069432/AI/NIAID NIH HHS/United States
GR  - UM1 AI068634/AI/NIAID NIH HHS/United States
GR  - UM1 AI069518/AI/NIAID NIH HHS/United States
GR  - UM1 AI069496/AI/NIAID NIH HHS/United States
GR  - UM1 AI069463/AI/NIAID NIH HHS/United States
GR  - P30 AI027763/AI/NIAID NIH HHS/United States
GR  - UM1 AI106701/AI/NIAID NIH HHS/United States
GR  - U01AI068636/AI/NIAID NIH HHS/United States
GR  - UM1 AI068636/AI/NIAID NIH HHS/United States
GR  - UM1 AI069399/AI/NIAID NIH HHS/United States
GR  - U01 AI068636/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - J Acquir Immune Defic Syndr
JT  - Journal of acquired immune deficiency syndromes (1999)
JID - 100892005
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Adult
MH  - Anti-Retroviral Agents/*therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Female
MH  - HIV Infections/*complications/*drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*pathology
MH  - Male
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Tuberculosis/*complications/*pathology
PMC - PMC3943693
MID - NIHMS542862
EDAT- 2013/11/15 06:00
MHDA- 2014/04/22 06:00
PMCR- 2015/04/01
CRDT- 2013/11/15 06:00
PHST- 2013/11/15 06:00 [entrez]
PHST- 2013/11/15 06:00 [pubmed]
PHST- 2014/04/22 06:00 [medline]
PHST- 2015/04/01 00:00 [pmc-release]
AID - 10.1097/QAI.0000000000000030 [doi]
PST - ppublish
SO  - J Acquir Immune Defic Syndr. 2014 Apr 1;65(4):423-8. doi: 
      10.1097/QAI.0000000000000030.