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

doi:10.1177/1545109710361537

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

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Research output: Contribution to journal › Article › peer-review

Abstract

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 language	English
Journal	Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)
Volume	9
Issue number	2
Pages (from-to)	104-8
Number of pages	5
ISSN	1545-1097
DOIs	https://doi.org/10.1177/1545109710361537
Publication status	Published - 18-Feb-2010

Keywords

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

Access to Document

10.1177/1545109710361537

Cite this

Eshun-Wilson, I., Havers, F., Nachega, J. B., Prozesky, H. W., Taljaard, J. J., Zeier, M. D., Cotton, M., Simon, G., & Soentjens, P. (2010). Evaluation of paradoxical TB-associated IRIS with the use of standardized case definitions for resource-limited settings. Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002), 9(2), 104-8. https://doi.org/10.1177/1545109710361537

Eshun-Wilson, Ingrid ; Havers, Fiona ; Nachega, Jean B ; Prozesky, Hans W ; Taljaard, Jantjie J ; Zeier, Michele D ; Cotton, Mark ; Simon, Gary ; Soentjens, Patrick. / Evaluation of paradoxical TB-associated IRIS with the use of standardized case definitions for resource-limited settings. In: Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002). 2010 ; Vol. 9, No. 2. pp. 104-8.

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abstract = "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.",

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

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Eshun-Wilson, I, Havers, F, Nachega, JB, Prozesky, HW, Taljaard, JJ, Zeier, MD, Cotton, M, Simon, G & Soentjens, P 2010, 'Evaluation of paradoxical TB-associated IRIS with the use of standardized case definitions for resource-limited settings', Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002), vol. 9, no. 2, pp. 104-8. https://doi.org/10.1177/1545109710361537

Evaluation of paradoxical TB-associated IRIS with the use of standardized case definitions for resource-limited settings. / Eshun-Wilson, Ingrid; Havers, Fiona; Nachega, Jean B; Prozesky, Hans W; Taljaard, Jantjie J; Zeier, Michele D; Cotton, Mark; Simon, Gary; Soentjens, Patrick.

In: Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002), Vol. 9, No. 2, 18.02.2010, p. 104-8.

Research output: Contribution to journal › Article › peer-review

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T1 - Evaluation of paradoxical TB-associated IRIS with the use of standardized case definitions for resource-limited settings

AU - Eshun-Wilson, Ingrid

AU - Havers, Fiona

AU - Nachega, Jean B

AU - Prozesky, Hans W

AU - Taljaard, Jantjie J

AU - Zeier, Michele D

AU - Cotton, Mark

AU - Simon, Gary

AU - Soentjens, Patrick

PY - 2010/2/18

Y1 - 2010/2/18

N2 - 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.

AB - 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.

KW - AIDS-Related Opportunistic Infections/immunology

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KW - Anti-HIV Agents/therapeutic use

KW - CD4 Lymphocyte Count

KW - Cohort Studies

KW - Developing Countries

KW - Female

KW - HIV Infections/complications

KW - HIV-1

KW - Humans

KW - Immune Reconstitution Inflammatory Syndrome/etiology

KW - Male

KW - Mycobacterium tuberculosis

KW - Reference Standards

KW - Retrospective Studies

KW - South Africa

KW - Tuberculosis/complications

U2 - 10.1177/1545109710361537

DO - 10.1177/1545109710361537

M3 - Article

C2 - 20160249

VL - 9

SP - 104

EP - 108

JO - Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)

JF - Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)

SN - 1545-1097

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