HIV
and Hepatitis.com Coverage of the 14th
Annual Conference on Retroviruses and Opportunistic Infections (14th CROI) February
25 - 28, 2007, Los Angeles, CA
Risk
of TB-associated Immune Reconstitution Disease Is High in South African Patients
Initiating Antiretroviral Therapy with Low Baseline CD4 Cell Counts
In
Sub-Saharan Africa, active infection with tuberculosis
(TB) is highly prevalent among HIV positive patients receiving HAART. As a
result, these individuals are at a high risk for developing TB-related immune
reconstitution disease (IRD) (also known as immune reconstitution inflammatory
syndrome, or IRIS) soon after initiating antiretroviral therapy. However, there
are scant data available concerning the risk factors or the frequency and outcomes
of IRD among these patients.
The
current study, presented at the 14th Conference on Retroviruses and Opportunistic
Infections last month in Los Angeles, was a retrospective analysis of data collected
from a cohort of patients enrolled over a 3-year period in a community-based antiretroviral
treatment program in South Africa. The researchers evaluated patients receiving
TB treatment at the time they initiated antiretroviral therapy, and ascertained
cases of TB-associated IRDS during the first 4 months on HAART.
In a multivariate
analysis, the risk of developing IRD was strongly associated with early antiretroviral
therapy initiation and low baseline CD4 cell counts. Overall, 7 patients (4%)
required secondary health care for IRD and only 2 patients (1%) died.
In
conclusion, the authors wrote, "The risk of TB-associated IRD in this setting
is very high for those with low baseline CD4 cell counts initiating antiretroviral
therapy early in the course of anti-tuberculosis treatment. However, most cases
were self-limiting; overall secondary health care utilisation and mortality risk
from IRD were low."
Reference S
Lawn, L Myer, L G Bekker, and others. TB-associated Immune Reconstitution Disease:
Incidence, Risk Factors, and Effect within an ART Program in Sub-Saharan Africa.
14th Conference on Retroviruses and Opportunistic Infections; February 25-28,
2007; Los Angeles, California. Abstract 863 (poster).
