PMID- 27677424 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210924 IS - 1471-2334 (Electronic) IS - 1471-2334 (Linking) VI - 16 IP - 1 DP - 2016 Sep 27 TI - Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors. PG - 518 LID - 518 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. FAU - Bana, Tasnim M AU - Bana TM AD - Department of Medicine, University of Cape Town, Observatory, 7925, South Africa. FAU - Lesosky, Maia AU - Lesosky M AD - Department of Medicine, University of Cape Town, Observatory, 7925, South Africa. FAU - Pepper, Dominique J AU - Pepper DJ AD - Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, USA. FAU - van der Plas, Helen AU - van der Plas H AD - Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa. FAU - Schutz, Charlotte AU - Schutz C AD - Department of Medicine, University of Cape Town, Observatory, 7925, South Africa. AD - Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa. FAU - Goliath, Rene AU - Goliath R AD - Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa. FAU - Morroni, Chelsea AU - Morroni C AD - Institute for Women's Health and Institute for Global Health, University College London, London, UK. FAU - Mendelson, Marc AU - Mendelson M AD - Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa. FAU - Maartens, Gary AU - Maartens G AD - Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa. FAU - Wilkinson, Robert J AU - Wilkinson RJ AD - Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa. AD - Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa. AD - Francis Crick Institute, London, NW7 1AA, UK. AD - Department of Medicine, Imperial College London, London, W2 1PG, UK. FAU - Meintjes, Graeme AU - Meintjes G AD - Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa. Graeme.meintjes@uct.ac.za. AD - Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa. Graeme.meintjes@uct.ac.za. AD - Department of Medicine, Imperial College London, London, W2 1PG, UK. Graeme.meintjes@uct.ac.za. LA - eng GR - 098316/WT_/Wellcome Trust/United Kingdom PT - Journal Article DEP - 20160927 PL - England TA - BMC Infect Dis JT - BMC infectious diseases JID - 100968551 CIN - AIDS. 2021 May 1;35(6):995-997. PMID: 33821825 PMC - PMC5039896 OTO - NOTNLM OT - Glucocorticoids OT - HIV OT - IRIS OT - Immune reconstitution inflammatory syndrome OT - Tuberculosis EDAT- 2016/09/30 06:00 MHDA- 2016/09/30 06:01 PMCR- 2016/09/27 CRDT- 2016/09/29 06:00 PHST- 2016/01/26 00:00 [received] PHST- 2016/09/17 00:00 [accepted] PHST- 2016/09/29 06:00 [entrez] PHST- 2016/09/30 06:00 [pubmed] PHST- 2016/09/30 06:01 [medline] PHST- 2016/09/27 00:00 [pmc-release] AID - 10.1186/s12879-016-1850-2 [pii] AID - 1850 [pii] AID - 10.1186/s12879-016-1850-2 [doi] PST - epublish SO - BMC Infect Dis. 2016 Sep 27;16(1):518. doi: 10.1186/s12879-016-1850-2.