565. Incidence and Outcomes of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome (IRIS) Following Antiretroviral Therapy (ART) in HIV-Infected Patients
Session: Poster Abstract Session: Tuberculosis Treatment and Outcome
Thursday, October 27, 2016
Room: Poster Hall
Background: Tuberculosis(TB)-associated IRIS posed a substantial early complication following antiretroviral therapy (ART) in area with HIV-TB co-endemic. However, the outcome of TB-IRIS is not well defined.This study aimed to determine the incidence and outcome of paradoxical and unmasking TB-IRIS after ART initiation.

Methods: We performed a retrospective cohort study of HIV-infected patients starting ART at Siriraj Hospital between January 2010 and December 2013. Paradoxical and unmasking TB-IRIS was diagnosed using published case criteria. The outcome obtained were mortality, rate of hospitalization, the increment of CD4 cell count and the proportion of virological suppression at 6 months and 1 years of ART initiation. 

Results: A total of 370 HIV-infected patients were included, with a mean age of 40.02 (SD 10.36). The median CD4 cell count at baseline was 44 cell/ mm3 (IQR 17.5-91.5). Of 120 patients whom TB were diagnosed before starting ART, 21(17.5%) developed paradoxical TB-RIS at a median time of 24 days (IQR 14-49). Of 250 patients who was not receiving TB treatment when ART was initiated, 18 (7.2%) experienced ART-associated TB, with a median time of 47.5 days (IQR 23-98). Of which, 13 (5.2%) was identified as unmasking TB-IRIS. Four of 370 (1.08%) patients died within one year after HAART initiation. Those who died did not develop TB-IRIS. As compared to those without IRIS, paradoxical (94 vs.114, p=0.365) and ART-associated TB (104 vs.114, p=0.43) had no difference in the increment of CD4 cell count, and the proportion of virological suppression at 6 months (88.9%, 93.3% vs. 88.8%, p=1.00). However, those with paradoxical TB-IRIS or ART associated TB were hospitalized within 6 months after ART more frequently than those without TB-IRIS (33.3%, 33.3% vs. 8.2%, respectively, p = 0.001) and required more invasive procedures than those without TB-IRIS (42.9%, 55.6% vs. 3.3%, respectively, p<0.001)

Conclusion: The occurrence of TB-IRIS is not uncommon. Even though patients with TB-IRIS were hospitalized and underwent an invasive procedure far more frequently than those without TB-IRIS, none of those died. ART should be provided early and fear of any type of IRIS should not be the reason to defer ART in area with HIV-TB co-endemic. 

Nasikarn Angkasekwinai, MD, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, Chanin Chareesil, MD, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand and Peerawong Weerarak, MD, Department of Preventive Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Disclosures:

N. Angkasekwinai, None

C. Chareesil, None

P. Weerarak, None

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