Meningitis as fatal complication of TB-IRIS with HIV in north India
Immune reconstitution inflammatory syndrome (IRIS) proved a frequent complication in tuberculosis patients starting antiretroviral therapy (ART) in north India. Meningitis was a common component of TB-IRIS and was often fatal.
Tuberculosis is the most frequent coinfection in HIV-positive
people in many countries, including India. TB-IRIS often
develops when ART begins in patients with TB coinfection.
Researchers undertook this retrospective chart review to
assess the frequency, clinical presentation, and outcome of
paradoxical TB-IRIS in HIV-positive patients in a TB hospital
in New Delhi.
The study involved 514 HIV-positive people enrolled between
January 2006 and December 2008. Of 103 patients who received
ART and TB therapy simultaneously, paradoxical TB-IRIS
developed in 13 (12.6%).
TB-IRIS developed a median of 15 days after people started ART
(interquartile range [IQR] 15 to 36). TB-IRIS patients were
older than those without TB-IRIS but could not be
distinguished by CD4 count, duration of TB therapy before ART,
or TB treatment outcome.
Clinical manifestations of TB-IRIS included new
lymphadenopathy in 3 patients, increased size of existing
lymphadenopathy in 3, worsening of existing pulmonary lesions
in 2, new pleural effusion in 1, and prolonged high-grade
fever in 2.
Meningitis developed in 4 of 13 patients (31%) with TB-IRIS.
While 8 patients with TB-IRIS had a full recovery, 5 died,
including 3 of 4 with meningitis.
“Meningitis is a potentially life threatening
manifestation of TB-IRIS,” the authors conclude.
Therefore they propose that “future studies in areas
with high prevalence of M. tuberculosis infection
should . . . address the issue of how patients at risk of
developing paradoxical central nervous system TB-IRIS might be
identified.”
Source: Upasna Agarwal, Amitabh
Kumar, Digamber Behera, Martyn French, Patricia Price.
Tuberculosis associated immune reconstitution inflammatory
syndrome in patients infected with HIV: meningitis a
potentially life threatening manifestation.
AIDS Research and Therapy. 2012; 9: 17.
Complete article provided by AIDS Research and Therapy, an open-access journal
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