LRS Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, near Qutab Minar, New Delhi, India, 110 030.
AIDS Res Ther. 2012 May 23;9(1):17. doi: 10.1186/1742-6405-9-17.
Tuberculosis (TB) is the most common co infection in HIV-infected persons in India, requiring concomitant administration of anti TB and antiretroviral therapies. Paradoxical worsening of tuberculosis after anti-retroviral therapy (ART) initiation is frequently seen.
To study the frequency, clinical presentation and outcome of paradoxical tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS) in HIV infected patients in a TB hospital in North India.
A retrospective chart review of HIV-infected TB patients on anti-tubercular treatment (ATT) at time of ART initiation over a 3 year period. Medical records were reviewed for clinical manifestations and outcome in patients who developed TB-IRIS.
514 HIV-infected patients were enrolled between January 2006 and December 2008. Thirteen (12.6%) of 103 patients who had received ART and ATT simultaneously developed paradoxical TB-IRIS. Clinical presentations of paradoxical TB-IRIS included new lymphadenopathy (n = 3), increase in size of existing lymphadenopathy (n = 3), worsening of existing pulmonary lesions (n = 2), appearance of new pleural effusion (n = 1) and prolonged high grade fever (n = 2). Four patients developed new tubercular meningitis as manifestation of TB-IRIS. Our cases developed TB-IRIS a median of 15 days after starting ART (IQR 15-36). TB-IRIS patients were older (> 35 years) than those with no IRIS (P = 0.03), but were not distinguishable by CD4 T-cell count, duration of ATT before ART or the outcome of TB treatment. Eight (62%) patients had a complete recovery while 5 (38%) patients with TB-IRIS died, of which majority (n = 3) had meningitis.
Paradoxical TB-IRIS is a frequent problem during concomitant ATT and ART in HIV-TB co infected patients in north India. Meningitis is a potentially life threatening manifestation of TB-IRIS.
在印度，结核分枝杆菌（TB）是 HIV 感染者最常见的合并感染，需要同时进行抗结核和抗逆转录病毒治疗。在开始抗逆转录病毒治疗（ART）后，常常会出现结核分枝杆菌的治疗矛盾恶化。
在印度北部的一家结核病医院，研究 HIV 感染患者中抗结核治疗（ATT）同时开始 ART 时，与结核相关的免疫重建炎症综合征（TB-IRIS）的发生频率、临床表现和结局。
对 2006 年 1 月至 2008 年 12 月期间同时接受抗结核和 ART 的 HIV 感染结核病患者的病历进行回顾性图表审查。对发生 TB-IRIS 的患者的临床表现和结局进行评估。
共纳入 514 例 HIV 感染患者。在 103 例同时接受 ART 和 ATT 的患者中，有 13 例（12.6%）发生了治疗矛盾的 TB-IRIS。TB-IRIS 的临床表现包括新的淋巴结病（n=3）、现有淋巴结病增大（n=3）、原有肺部病变恶化（n=2）、新发胸腔积液（n=1）和持续性高热（n=2）。4 例患者表现为新的结核性脑膜炎，为 TB-IRIS 的表现。我们的病例在开始 ART 后中位数 15 天（IQR 15-36）出现 TB-IRIS。TB-IRIS 患者比无 IRIS 患者年龄更大（>35 岁）（P=0.03），但无法通过 CD4 T 细胞计数、ART 前 ATT 持续时间或 TB 治疗结局来区分。8 例（62%）患者完全康复，而 5 例（38%）TB-IRIS 患者死亡，其中多数（n=3）为脑膜炎。
在印度北部的 HIV-TB 合并感染患者中，同时进行 ATT 和 ART 时，治疗矛盾的 TB-IRIS 是一个常见问题。脑膜炎是 TB-IRIS 潜在的危及生命的表现。
