Methods: Retrospective study of patients diagnosed with TB after starting HAART, from May 2009 to November 2010, done at a Tertiary Academic Hospital. Those with adverse drug reactions and poor adherence to HAART were excluded. Patients were followed up for 18 months after the diagnosis of TB. IRIS was diagnosed as per ‘International Network for the Study of HIV associated IRIS’ criteria.
Results: 199 ART naive patients were started on HAART during the study period, of which 42 were excluded. 31 developed IRIS, of which 15 (48.3 %) had TB- IRIS (incidence of 9.5%). Extra pulmonary TB, involving lymph nodes(3/15), pleura(1/15), pericardium(1/15), meninges(1/15), testis(1/15) and disseminated (1/15), was the predominant form (8/15, 53.3%). The commonest symptoms were fatigue and weight loss. Pre-treatment Tuberculin Skin Test was negative in all patients but became positive in 6/15 patients with TB. Risk factors for TB-IRIS were age >40, male sex, MSM, smoking, alcoholism, low pretreatment CD4 count <115cells/µL, >1 opportunistic infections at start of HAART and advanced WHO stage. A pre-HAART low hemoglobin (<12gm/dl), high ESR (>58 mm/hr) and raised ALP( >178 IU/L) were common in patients who developed TB. Mean baseline CD4 was 104.6±73.9 cells/µL and mean duration of onset of TB was 20 ± 27 weeks. All were treated with standard anti-tuberulous treatment (ATT), along with continuation of Efavirenz based HAART. One patient developed ATT induced hepatitis during the course of the treatment. All patients had clinical and bacteriological improvement.
Conclusion: Tuberculosis is the commonest form of IRIS in endemic areas like India and it is a challenge in HIV management in resource limited settings requiring high index of suspicion for early diagnosis and prompt treatment. ATT is effective in HIV patients on HAART, and patients can be successfully continued on an Efavirenz-based HAART while on a ATT.
C. N. Jacob,
R. Jayaprakash, None
S. Kurian, None