在开始联合抗逆转录病毒治疗后，HIV 感染者结核病“免疫重建炎症综合征”表现的风险因素。

Risk factors for 'unmasking immune reconstitution inflammatory syndrome' presentation of tuberculosis following combination antiretroviral therapy initiation in HIV-infected patients.

机构信息

Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.

出版信息

AIDS. 2010 Jun 19;24(10):1519-25. doi: 10.1097/qad.0b013e3283396007.

DOI:10.1097/qad.0b013e3283396007

PMID:20549841

Abstract

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.

摘要

目的

确定在开始联合抗逆转录病毒治疗（cART）后，HIV 感染者中出现结核相关免疫重建炎症综合征（TB-IRIS）的特征和危险因素，迄今为止尚未对此进行评估。

设计

回顾性单中心队列研究。

方法

回顾了在开始 cART 后诊断为结核病的 HIV 感染者的病历。使用临时共识定义确定是否出现 IRIS 。比较了出现和未出现 TB-IRIS 的患者的特征。采用病例对照设计，确定开始 cART 的患者出现 TB-IRIS 的危险因素。

结果

在诊断为结核病时正在接受 cART 的 47 名患者中，有 11 名发生了 TB-IRIS（23%）。他们的 CD4%（9 比 14，P=0.02）更低，基线时 HIV-RNA 载量更高（5.2 比 4.0 log，P=0.005），并且在开始 cART 后 1 个月时，CD4%的增加与 HIV-RNA 的下降幅度更大（+7 比+3 log，P=0.02，和-3.2 比-0.8 log，P=0.005）。在病例对照研究中，出现 IRIS 的危险因素是来自非洲国家（65 比 18%，P=0.007）、更高的基线 HIV-RNA 载量（5.2 比 4.7 log，P=0.01）、更大的 CD4%增加（+7 比+2，P=0.0001）和开始 cART 后 1 个月时 HIV-RNA 下降超过 3 个对数（73 比 27%，P=0.02）。