Tuberculosis (TB)-associated immune reconstitution inflammatory syndrome in TB-HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes

Hong Yien Tan, Yean Kong Yong, Sin How Lim, Sasheela Ponnampalavanar, Sharifah Faridah Syed Omar, Yong Kek Pang, Adeeba Binti Kamarulzaman, Patricia Price, Suzanne Mary Crowe, Martyn A French

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Abstract

Background Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important early complication of antiretroviral therapy (ART) in countries with high rates of endemic TB, but data from South-East Asia are incomplete. Identification of prevalence, risk factors and treatment outcomes of TB-IRIS in Malaysia was sought. Methods: A 3-year retrospective study was conducted among TB-HIV co-infected patients treated at the University of Malaya Medical Centre. Simple and adjusted logistic regressions were used to identify the predictors for TB-IRIS while Cox regression was used to assess the influence of TB-IRIS on long-term CD4 T-cell recovery. Results: One hundred and fifty-three TB-HIV patients were enrolled, of whom 106 had received both anti-TB treatment (ATT) and ART. The median (IQR) baseline CD4 T-cell count was 52 cells L-1 (13-130 cells L-1). Nine of 96 patients (9.4 ) developed paradoxical TB-IRIS and eight developed unmasking TB-IRIS, at a median (IQR) time of 27 (12-64) and 19 (14-65) days, respectively. In adjusted logistic regression analysis, only disseminated TB was predictive of TB-IRIS [OR: 10.7 (95 CI: 1.2-94.3), P=0.032]. Mortality rates were similar for TB-IRIS (n=1, 5.9 ) and non-TB-IRIS (n=5, 5.7 ) patients and CD4 T-cell recovery post-ART was not different between the two groups (P=0.363). Conclusion: Disseminated TB was a strong independent predictor of TB-IRIS in Malaysian HIV-TB patients after commencing ART. This finding underscores the role of a high pathogen load in the pathogenesis of TB-IRIS; so interventions that reduce pathogen load before ART may benefit HIV patients with disseminated TB.
Original languageEnglish
Pages (from-to)532 - 539
Number of pages8
JournalSexual Health
Volume11
Issue number6
DOIs
Publication statusPublished - 2014

Cite this

Tan, Hong Yien ; Yong, Yean Kong ; Lim, Sin How ; Ponnampalavanar, Sasheela ; Omar, Sharifah Faridah Syed ; Pang, Yong Kek ; Kamarulzaman, Adeeba Binti ; Price, Patricia ; Crowe, Suzanne Mary ; French, Martyn A. / Tuberculosis (TB)-associated immune reconstitution inflammatory syndrome in TB-HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes. In: Sexual Health. 2014 ; Vol. 11, No. 6. pp. 532 - 539.
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title = "Tuberculosis (TB)-associated immune reconstitution inflammatory syndrome in TB-HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes",
abstract = "Background Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important early complication of antiretroviral therapy (ART) in countries with high rates of endemic TB, but data from South-East Asia are incomplete. Identification of prevalence, risk factors and treatment outcomes of TB-IRIS in Malaysia was sought. Methods: A 3-year retrospective study was conducted among TB-HIV co-infected patients treated at the University of Malaya Medical Centre. Simple and adjusted logistic regressions were used to identify the predictors for TB-IRIS while Cox regression was used to assess the influence of TB-IRIS on long-term CD4 T-cell recovery. Results: One hundred and fifty-three TB-HIV patients were enrolled, of whom 106 had received both anti-TB treatment (ATT) and ART. The median (IQR) baseline CD4 T-cell count was 52 cells L-1 (13-130 cells L-1). Nine of 96 patients (9.4 ) developed paradoxical TB-IRIS and eight developed unmasking TB-IRIS, at a median (IQR) time of 27 (12-64) and 19 (14-65) days, respectively. In adjusted logistic regression analysis, only disseminated TB was predictive of TB-IRIS [OR: 10.7 (95 CI: 1.2-94.3), P=0.032]. Mortality rates were similar for TB-IRIS (n=1, 5.9 ) and non-TB-IRIS (n=5, 5.7 ) patients and CD4 T-cell recovery post-ART was not different between the two groups (P=0.363). Conclusion: Disseminated TB was a strong independent predictor of TB-IRIS in Malaysian HIV-TB patients after commencing ART. This finding underscores the role of a high pathogen load in the pathogenesis of TB-IRIS; so interventions that reduce pathogen load before ART may benefit HIV patients with disseminated TB.",
author = "Tan, {Hong Yien} and Yong, {Yean Kong} and Lim, {Sin How} and Sasheela Ponnampalavanar and Omar, {Sharifah Faridah Syed} and Pang, {Yong Kek} and Kamarulzaman, {Adeeba Binti} and Patricia Price and Crowe, {Suzanne Mary} and French, {Martyn A}",
year = "2014",
doi = "10.1071/SH14093",
language = "English",
volume = "11",
pages = "532 -- 539",
journal = "Sexual Health",
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Tan, HY, Yong, YK, Lim, SH, Ponnampalavanar, S, Omar, SFS, Pang, YK, Kamarulzaman, AB, Price, P, Crowe, SM & French, MA 2014, 'Tuberculosis (TB)-associated immune reconstitution inflammatory syndrome in TB-HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes', Sexual Health, vol. 11, no. 6, pp. 532 - 539. https://doi.org/10.1071/SH14093

Tuberculosis (TB)-associated immune reconstitution inflammatory syndrome in TB-HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes. / Tan, Hong Yien; Yong, Yean Kong; Lim, Sin How; Ponnampalavanar, Sasheela; Omar, Sharifah Faridah Syed; Pang, Yong Kek; Kamarulzaman, Adeeba Binti; Price, Patricia; Crowe, Suzanne Mary; French, Martyn A.

In: Sexual Health, Vol. 11, No. 6, 2014, p. 532 - 539.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Tuberculosis (TB)-associated immune reconstitution inflammatory syndrome in TB-HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes

AU - Tan, Hong Yien

AU - Yong, Yean Kong

AU - Lim, Sin How

AU - Ponnampalavanar, Sasheela

AU - Omar, Sharifah Faridah Syed

AU - Pang, Yong Kek

AU - Kamarulzaman, Adeeba Binti

AU - Price, Patricia

AU - Crowe, Suzanne Mary

AU - French, Martyn A

PY - 2014

Y1 - 2014

N2 - Background Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important early complication of antiretroviral therapy (ART) in countries with high rates of endemic TB, but data from South-East Asia are incomplete. Identification of prevalence, risk factors and treatment outcomes of TB-IRIS in Malaysia was sought. Methods: A 3-year retrospective study was conducted among TB-HIV co-infected patients treated at the University of Malaya Medical Centre. Simple and adjusted logistic regressions were used to identify the predictors for TB-IRIS while Cox regression was used to assess the influence of TB-IRIS on long-term CD4 T-cell recovery. Results: One hundred and fifty-three TB-HIV patients were enrolled, of whom 106 had received both anti-TB treatment (ATT) and ART. The median (IQR) baseline CD4 T-cell count was 52 cells L-1 (13-130 cells L-1). Nine of 96 patients (9.4 ) developed paradoxical TB-IRIS and eight developed unmasking TB-IRIS, at a median (IQR) time of 27 (12-64) and 19 (14-65) days, respectively. In adjusted logistic regression analysis, only disseminated TB was predictive of TB-IRIS [OR: 10.7 (95 CI: 1.2-94.3), P=0.032]. Mortality rates were similar for TB-IRIS (n=1, 5.9 ) and non-TB-IRIS (n=5, 5.7 ) patients and CD4 T-cell recovery post-ART was not different between the two groups (P=0.363). Conclusion: Disseminated TB was a strong independent predictor of TB-IRIS in Malaysian HIV-TB patients after commencing ART. This finding underscores the role of a high pathogen load in the pathogenesis of TB-IRIS; so interventions that reduce pathogen load before ART may benefit HIV patients with disseminated TB.

AB - Background Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important early complication of antiretroviral therapy (ART) in countries with high rates of endemic TB, but data from South-East Asia are incomplete. Identification of prevalence, risk factors and treatment outcomes of TB-IRIS in Malaysia was sought. Methods: A 3-year retrospective study was conducted among TB-HIV co-infected patients treated at the University of Malaya Medical Centre. Simple and adjusted logistic regressions were used to identify the predictors for TB-IRIS while Cox regression was used to assess the influence of TB-IRIS on long-term CD4 T-cell recovery. Results: One hundred and fifty-three TB-HIV patients were enrolled, of whom 106 had received both anti-TB treatment (ATT) and ART. The median (IQR) baseline CD4 T-cell count was 52 cells L-1 (13-130 cells L-1). Nine of 96 patients (9.4 ) developed paradoxical TB-IRIS and eight developed unmasking TB-IRIS, at a median (IQR) time of 27 (12-64) and 19 (14-65) days, respectively. In adjusted logistic regression analysis, only disseminated TB was predictive of TB-IRIS [OR: 10.7 (95 CI: 1.2-94.3), P=0.032]. Mortality rates were similar for TB-IRIS (n=1, 5.9 ) and non-TB-IRIS (n=5, 5.7 ) patients and CD4 T-cell recovery post-ART was not different between the two groups (P=0.363). Conclusion: Disseminated TB was a strong independent predictor of TB-IRIS in Malaysian HIV-TB patients after commencing ART. This finding underscores the role of a high pathogen load in the pathogenesis of TB-IRIS; so interventions that reduce pathogen load before ART may benefit HIV patients with disseminated TB.

UR - http://www.publish.csiro.au/index.cfm?paper=SH14093

U2 - 10.1071/SH14093

DO - 10.1071/SH14093

M3 - Article

VL - 11

SP - 532

EP - 539

JO - Sexual Health

JF - Sexual Health

SN - 1448-5028

IS - 6

ER -