High incidence of IRIS amongst HIV-positive TB patients starting HAART in India

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High incidence of IRIS amongst HIV-positive TB patients starting

HAART in India

, Wednesday, December 08, 2004

A high incidence of immune reconstitution inflammatory syndrome

(IRIS) amongst HIV-positive patients with tuberculosis (TB) in India

who commenced HAART shortly after TB treatment has been reported in

the December 15th edition of the Journal of Acquired Immune

Deficiency Syndromes. The investigators believe that their findings

underscore the need for clinical trials in resource limited settings

to better understand when to initiate HAART in the context of active

opportunistic infections.

IRIS in individuals with TB during treatment with HAART has been

well described in richer countries. As antiretroviral drugs become

more widely available in resource limited settings, investigators in

India wished to determine the incidence of IRIS amongst HIV-positive

patients with high rates of tuberculosis commencing HAART.

A total of 333 adult HIV-positive patients who received generic

HAART at the YRG CARE facility in Chennai, India, were included in

the investigators analysis.

At the initiation of HAART, 144 individuals (44%) had active TB. The

mean CD4 cell count of these patients at the time of HAART

initiation was 122 cells/mm3, and after six months of anti-HIV

therapy the mean increase in CD4 cell count was 130 cells/mm3.

Eleven patients developed IRIS during the course of the study. Their

CD4 cell count at baseline (mean 124 cells/mm3) and their mean

increase in CD4 cell count during anti-HIV therapy (124 cells/mm3)

did not differ from patients who did not develop IRIS (p = 0.8).

IRIS developed a median of 42 days after starting HAART and the

incidence of IRIS was 15 cases per 100 patient years. The median

duration between the initiation of TB treatment and starting HAART

was similar between patients regardless of whether or not they

developed IRIS (p = 0.8).

Patients were treated with short-course cortico-steroids, aspiration

and were counselled to continue their anti-HIV therapy.

" In this cohort from a resource-limited setting with a high

background rate of TB, there is a high incidence of IRS " , write the

investigators. They conclude by calling for clinical trials in

resource limited settings " to help physicians better understand when

to initiate antiretroviral therapy in the context of opportunistic

infections " and also note that without adequate guidelines, doctors

treating HIV in poorer countries " will face a new set of challenges

to safe and effective therapy. "

Reference

Kumarasamy N et al. Incidence of immune reconstitution syndrome in

HIV/tuberculosis-coinfected patients after initiation of generic

antiretroviral therapy in India. J Acquir Immune Defic Syndr 37:

1574 – 1576, 2004.

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