%0 Journal Article
%T Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV: meningitis a potentially life threatening manifestation
%A Upasna Agarwal
%A Amitabh Kumar
%A Digamber Behera
%A Martyn French
%A Patricia Price
%J AIDS Research and Therapy
%D 2012
%I BioMed Central
%R 10.1186/1742-6405-9-17
%X 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¨C36). 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.
%K Tuberculosis
%K HIV
%K IRIS
%K Meningitis
%U http://www.aidsrestherapy.com/content/9/1/17/abstract