Frequency, severity and duration of immune reconstitution events in HIV-related tuberculosis

William Burman, Stephen Weis, A. Vernon, A. Khan, D. Benator, B. Jones, C. Silva, B. King, C. LaHart, B. Mangura, M. Weiner, W. El-Sadr

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Abstract

SETTING: Patients were enrolled in a prospective trial of rifabutin-based tuberculosis (TB) treatment for human immunodeficiency virus related TB. Antiretroviral therapy (ART) was encouraged, but not required. OBJECTIVE: To evaluate the frequency, risk factors and duration of immune reconstitution events. DESIGN: Patients were prospectively evaluated for immune reconstitution events, and all adverse event reports were reviewed to identify possible unrecognized events. RESULTS: Of 169 patients, 25 (15%) developed immune reconstitution events related to TB. All 25 were among the 137 patients who received ART during TB treatment, so the frequency in this subgroup was 18% (25/137). Risk factors for an immune reconstitution event in multivariate analysis were Black race, the presence of extra-pulmonary TB and a shorter interval from initiation of TB treatment to initiation of ART. The most common clinical manifestations were fever (64%), new or worsening adenopathy (52%) and worsening pulmonary infiltrates (40%). Twelve patients (48%) were hospitalized for a median of 7 days, six underwent surgery and 11 had needle aspiration. The median duration of events was 60 days (range 11-442). CONCLUSION: Immune reconstitution events were common among patients receiving ART during TB treatment, produced substantial morbidity and had a median duration of 2 months.

Original languageEnglish
Pages (from-to)1282-1289
Number of pages8
JournalInternational Journal of Tuberculosis and Lung Disease
Volume11
Issue number12
Publication statusPublished - 1 Dec 2007

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Keywords

  • Antiretroviral therapy
  • HIV
  • Immune reconstitution
  • Tuberculosis

Cite this

Burman, W., Weis, S., Vernon, A., Khan, A., Benator, D., Jones, B., ... El-Sadr, W. (2007). Frequency, severity and duration of immune reconstitution events in HIV-related tuberculosis. International Journal of Tuberculosis and Lung Disease, 11(12), 1282-1289.