Immune reconstitution syndrome in patients treated for HIV and tuberculosis in Rio de Janeiro

Brazilian Journal of Infectious Diseases

Fabiana C. Serra²  David Hadad¹  Renata L. Orofino²  Flavia Marinho²  Cristina Lourenço²  Mariza Morgado¹  Valeria Rolla² 

[1] ,Fiocruz Evandro Chagas Institute Research Rio de Janeiro

关键词: AIDS;    immune reconstitution syndrome;    tuberculosis;    HAART;    lymph node enlargement;    paradoxical reaction;   

DOI  :  10.1590/S1413-86702007000500004

来源: SciELO

【 摘 要 】

We made a retrospective longitudinal study from January 2000 to January 2003 to examine cases of immune reconstitution syndrome (IRS) and its incidence rate in tuberculosis (TB)-human immunodeficiency virus (HIV) co-infected patients. The incidence rate (IR) was calculated using a Poisson regression. The confidence interval (CI) that was stipulated was 95%. IRS occurred in 10/84 HIV and TB-positive patients; nine of them were on highly active anti-retroviral therapy (HAART) during a mean of 61.7 (±59) days following the introduction of antiretrovirals. Lymph-node enlargement was the sole clinical manifestation. CD4 counts were <100 cells/mm³in 50% of the patients, at the time of TB diagnosis. All but two patients were treated with prednisone, and recovered from TB within a mean of 91 days (±30 days). One relapse of TB was observed, but there were no IRS-related deaths. The incidence rate was higher (IR=11.18; CI, 1.41-88.76) in patients that had superficial lymph node enlargement at the moment of TB diagnosis (not associated with TB), extrapulmonary TB (IR=1.97; CI, 0.44-8.79), were antiretroviral naive (IR=1.85; CI, 0.48-7.16), and CD4 counts <100 cells/mm³ (IR=1.50; CI, 0.40-5.59), although with a wide CI. IRS was frequent in our sample, occurred more frequently in HIV-naive patients with lymph-node enlargement and extrapulmonary TB. No cases of new pulmonary lesions or worsening of pulmonary infiltrates were observed.

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