Deciphering TB-IRIS in HIV Patients: A Comprehensive Clinical and Microbiological Analysis
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Background
Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) coinfection presents a complex clinical challenge, with Tuberculosis-Immune Reconstitution Inflammatory Syndrome (TB-IRIS) emerging as a significant complication following antiretroviral therapy (ART) initiation. Understanding the clinical and microbiological characteristics of TB-IRIS is crucial for improving patient outcomes.
Methods
This prospective cohort study included 400 HIV-positive patients from the ART centre at King George’s Medical University, Lucknow, India. Patients were categorized based on TB status and monitored for the development of TB-IRIS following ART initiation. Clinical data, CD4 counts, and microbiological analyses, including drug susceptibility testing, were conducted. TB-IRIS was classified as paradoxical or unmasking, and outcomes were assessed over a one-year period.
Results
Among the 400 patients, 38 (9.5%) developed TB-IRIS, with 31 (81.6%) presenting unmasking TB-IRIS and 7 (18.4%) paradoxical TB-IRIS. Tubercular meningitis (TBM) was the most common manifestation (47.3%), followed by pulmonary TB (29.0%). The incidence of TB-IRIS was higher (15.4%) in patients who initiated ART within one month of starting anti-tuberculosis therapy (ATT) compared to those who started ART later (5.5%). A lower baseline CD4 count (<100 cells/µL) was significantly associated with a higher risk of TB-IRIS (p=0.003). The drug resistance analysis revealed 27.2% resistance to both isoniazid and rifampicin. Steroid therapy was administered to 13% of TB-IRIS patients. The overall cure/improvement rate was 71%, while the mortality rate was 23.6%. No patients discontinued ART during the study.
Conclusion
This study highlights the predominance of unmasking TB-IRIS in HIV patients initiating ART, particularly those with low baseline CD4 counts and early ART initiation post-ATT. The significant drug resistance observed underscores the need for robust diagnostic and treatment protocols. Improved management strategies are essential to enhance clinical outcomes in TB-IRIS patients.
