Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV: meningitis a potentially life threatening manifestation.
Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV: meningitis a potentially life threatening manifestation.
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DOI：
10.1186/1742-6405-9-17
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发表时间：
2012-05-23
影响因子：
2.2
通讯作者：
Price P
中科院分区：
文献类型：
--
作者：
Agarwal U;Kumar A;Behera D;French MA;Price P
结核病（TB）是印度艾滋病毒感染者中最常见的合并感染，需要同时给予抗TB和抗逆转录病毒治疗。抗逆转录病毒治疗（ART）开始后结核病的副作用恶化是常见的。研究印度北部一家结核病医院HIV感染患者中反常结核病相关免疫重建炎症综合征（TB-IRIS）的发生率、临床表现和结局。一项对3年内开始ART时接受抗结核治疗（ATT）的HIV感染结核病患者的回顾性图表审查。对发生TB-IRIS的患者的临床表现和结局的病历进行了审查。2006年1月至2008年12月期间，共招募了514名艾滋病毒感染者。103例同时接受ART和ATT的患者中有13例（12.6%）发生了矛盾的TB-IRIS。反常性TB-IRIS的临床表现包括新发淋巴结肿大（n = 3）、原有淋巴结肿大增大（n = 3）、原有肺部病变恶化（n = 2）、新发胸腔积液（n = 1）和持续高热（n = 2）。4例患者发展为新的结核性脑膜炎的表现TB-IRIS。我们的病例在开始抗逆转录病毒治疗后平均15天（IQR 15-36）发生TB-IRIS。TB-IRIS患者比非IRIS患者年龄大（> 35岁）（P = 0.03），但无法通过CD 4 T细胞计数、ART前ATT持续时间或TB治疗结果进行区分。8例（62%）患者完全康复，5例（38%）TB-IRIS患者死亡，其中大多数（n = 3）患有脑膜炎。副结核IRIS是一个常见的问题，同时ATT和ART在印度北部的艾滋病毒-结核病合并感染的患者。脑膜炎是TB-IRIS的一种潜在的危及生命的表现。
Tuberculosis (TB) is the most common co infection in HIV-infected persons in India, requiring concomitant administration of anti TB and antiretroviral therapies. Paradoxical worsening of tuberculosis after anti-retroviral therapy (ART) initiation is frequently seen. 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 15–36). 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.
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影响因子：
3.8
作者：
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通讯作者：
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影响因子：
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作者：
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作者：
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DOI：
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发表时间：
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影响因子：
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作者：
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作者：
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通讯作者：
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