Evaluation of paradoxical TB-associated IRIS with the use of standardized case definitions for resource-limited settings

Ingrid Eshun-Wilson, Fiona Havers, Jean B Nachega, Hans W Prozesky, Jantjie J Taljaard, Michele D Zeier, Mark Cotton, Gary Simon, Patrick Soentjens

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Standardized case definitions have recently been proposed by the International Network for the Study of HIV-associated immune reconstitution inflammatory syndrome (INSHI; [IRIS]) for use in resource-limited settings. We evaluated paradoxical tuberculosis (TB)-associated IRIS in a large cohort from a TB endemic setting with the use of these case definitions.

DESIGN: A retrospective cohort study.

METHOD: We reviewed records from 1250 South African patients who initiated antiretroviral therapy (ART) over a 5-year period.

RESULTS: A total of 333 (27%) of the patients in the cohort had prevalent TB at the initiation of ART. Of 54 possible paradoxical TB-associated IRIS cases, 35 fulfilled the INSHI case definitions (11% of TB cases).

CONCLUSIONS: INSHI-standardized case definitions were used successfully in identifying paradoxical TB-associated IRIS in this cohort and resulted in a similar proportion of TB IRIS cases (11%) as that reported in previous studies from resource-limited settings (8%-13%). This case definition should be evaluated prospectively.

Original languageEnglish
JournalJournal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)
Issue number2
Pages (from-to)104-8
Number of pages5
Publication statusPublished - 18-Feb-2010


  • AIDS-Related Opportunistic Infections/immunology
  • Adult
  • Anti-HIV Agents/therapeutic use
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Developing Countries
  • Female
  • HIV Infections/complications
  • HIV-1
  • Humans
  • Immune Reconstitution Inflammatory Syndrome/etiology
  • Male
  • Mycobacterium tuberculosis
  • Reference Standards
  • Retrospective Studies
  • South Africa
  • Tuberculosis/complications

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