Treatment outcomes of patients co-infected with tuberculosis and HIV at Chiang Mai University Hospital, Thailand

Limmahakhun, Sakkadech; Chaiwarith, Romanee; Nuntachit, Nontakan; Sirisanthana, Thira; Supparatpinyo, K

doi:10.1258/ijsa.2012.011291

Cited by 9 publications

(10 citation statements)

References 24 publications

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“…In several observational studies (n = 9) there was a significant association between earlier ART initiation following TB treatment and TB-IRIS risk in univariate analysis (see Supplementary table 1) [12,14,24,27,36,52,55,61,62]. This association remained significant in multivariate analysis in five studies [12,14,24,52,55].…”

Section: Interval Between Tb Treatment Initiation and Art Initiationmentioning

confidence: 96%

“…This association remained significant in multivariate analysis in five studies [12,14,24,52,55]. The interval between TB treatment and ART initiation was analyzed as a categorical variable in many studies.…”

Section: Interval Between Tb Treatment Initiation and Art Initiationmentioning

confidence: 99%

“…In a retrospective study by Breen, an interval <6 weeks versus 6 weeks-6 months was associated with a higher risk of TB-IRIS [61]. Narendran's prospective cohort study in India reported that interval <30 days was associated with TB-IRIS in univariate and multivariate analysis [12] In multivariate analysis in a retrospective study from Thailand, an interval <60 days versus >60 days was also found to be a significant risk factor [52]. The risk of paradoxical TB-IRIS was sixfold higher with earlier ART start in this study (odds ratio [OR]: 6.57; 95%CI: 1.61-26.86) [52].…”

Section: Interval Between Tb Treatment Initiation and Art Initiationmentioning

confidence: 99%

“…Narendran's prospective cohort study in India reported that interval <30 days was associated with TB-IRIS in univariate and multivariate analysis [12] In multivariate analysis in a retrospective study from Thailand, an interval <60 days versus >60 days was also found to be a significant risk factor [52]. The risk of paradoxical TB-IRIS was sixfold higher with earlier ART start in this study (odds ratio [OR]: 6.57; 95%CI: 1.61-26.86) [52]. In a retrospective observational study conducted at a primary care ART clinic in South Africa, an interval ≤30 days compared with >90 days was a risk factor for paradoxical TB-IRIS in a multivariate analysis [14].…”

Section: Interval Between Tb Treatment Initiation and Art Initiationmentioning

confidence: 99%

“…Shorter time from TB treatment to ART in days was significantly associated with paradoxical TB-IRIS [14,24,36,52,55,62]. In several studies, however, the risk of IRIS was not associated with duration of TB treatment at ART initiation [25,51,54].…”

Section: Interval Between Tb Treatment Initiation and Art Initiationmentioning

confidence: 99%

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Paradoxical TB-IRIS in HIV-infected Adults: a Systematic Review and Meta-analysis

et al. 2015

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Paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) was first described almost two decades ago. We undertook this systematic review and meta-analysis to collate findings across studies that have reported the incidence, clinical features, management and outcomes of paradoxical TB-IRIS. Forty studies that cumulatively reported 1048 paradoxical TB-IRIS cases were included. The pooled estimated incidence among patients with HIV-associated TB initiating antiretroviral therapy was 18% (95% CI: 16-21%). Frequent features were pulmonary and lymph node involvement. Hospitalization occurred in 25% (95% CI: 19-30%). In studies that reported treatment, corticosteroids were prescribed more frequently (38%; 95% CI: 27-48%) than nonsteroidal anti-inflammatory drugs (28%; 95% CI: 2-53%). Case fatality was 7% (95% CI: 4-11%), but death attributed to TB-IRIS occurred in 2% of cases (95% CI: 1-3%).

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Section: Interval Between Tb Treatment Initiation and Art Initiationmentioning

confidence: 96%

Section: Interval Between Tb Treatment Initiation and Art Initiationmentioning

confidence: 99%

Section: Interval Between Tb Treatment Initiation and Art Initiationmentioning

confidence: 99%

Section: Interval Between Tb Treatment Initiation and Art Initiationmentioning

confidence: 99%

Section: Interval Between Tb Treatment Initiation and Art Initiationmentioning

confidence: 99%

See 3 more Smart Citations

Paradoxical TB-IRIS in HIV-infected Adults: a Systematic Review and Meta-analysis

et al. 2015

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The Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome (TB-IRIS)

Sereti

Bisson

Meintjes

2019

HIV and Tuberculosis

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TB–HIV co‐infection: a catastrophic comradeship

Narendran

Swaminathan

2016

Oral Diseases

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The symbiotic association of tuberculosis (TB) and HIV poses a challenge to human survival. HIV complicates every aspect of TB including presentation, diagnosis and treatment. HIV–TB patients encounter unique problems like drug–drug interactions, cumulative toxicity, immune reconstitution inflammatory syndrome (IRIS), lower plasma drug levels and emergence of drug resistance during treatment despite adherence. TB may also be overdiagnosed in HIV due to a number of diseases that closely resemble TB. Notable among them are non‐tuberculous mycobacteria, Pneumocystis Jirovecii and Nocardia. Even though diagnostic procedures have improved over the years, patients in developing countries usually seek health care at later stage of the disease. Research data ascertains the duration of therapy for TB to be 6 months with rifampicin and isoniazid, reinforced with ethambutol and pyrazinamide in the first 2 months. The schedule of therapy is still debatable with daily regimens being preferred in the context of HIV. Many reasons exist for persistence of Mycobacterium Tuberculosis (M.TB) in sputum, or delayed‐clearance of TB from sputum smears in HIV, apart from emergence of drug resistance and non‐compliance. Acquired rifampicin resistance (ARR) is a unique phenomenon complicating HIV‐associated TB when an intermittent regimen of antituberculosis therapy (ATT) is used without timely initiation of highly active antiretroviral therapy (HAART), especially in patients harbouring isoniazid‐resistant strains Immune restoration is often incomplete (‘swiss cheese’ pattern) even with effective HAART if not started early. Immune reconstitution inflammatory syndrome (IRIS) is the paradoxical worsening of the patient's condition often with radiological deterioration, due to an enhanced immune response with HAART. IRIS occurs despite an effective virological suppression and a favourable response to ATT. The incidence of IRIS in HIV has reached up to 54%, requiring utilization of experts and tertiary care which forms an obstacle to the decentralization of patients in the ART programme. Research in HIV–TB immunology and management needs further exploration in order to understand the diseases and offer appropriate treatment. The following paragraphs provide scientific evidences generated through research that could potentially guide management.

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Treatment outcomes of patients co-infected with tuberculosis and HIV at Chiang Mai University Hospital, Thailand

Cited by 9 publications

References 24 publications

Paradoxical TB-IRIS in HIV-infected Adults: a Systematic Review and Meta-analysis

Paradoxical TB-IRIS in HIV-infected Adults: a Systematic Review and Meta-analysis

The Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome (TB-IRIS)

TB–HIV co‐infection: a catastrophic comradeship

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