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

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    Fulltext not available
    Authors
    Tan, H.Y.
    Yong, Y.K.
    Lim, S.H.
    Ponnampalavanar, S.
    Omar, S.
    Pang, Y.K.
    Kamarulzaman, A.
    Price, Patricia
    Crowe, S.
    French, M.
    Date
    2014
    Type
    Journal Article
    
    Metadata
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    Citation
    Tan, H.Y. and Yong, Y.K. and Lim, S.H. and Ponnampalavanar, S. and Omar, S. and Pang, Y.K. and Kamarulzaman, A. et al. 2014. Tuberculosis (TB)-associated immune reconstitution inflammatory syndrome in TB-HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes. Sexual Health. 11: pp. 532-539.
    Source Title
    Sexual Health
    DOI
    10.1071/SH14093
    ISSN
    1448-5028
    URI
    http://hdl.handle.net/20.500.11937/29535
    Collection
    • Curtin Research Publications
    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 µL–1 (13–130 cells µL–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.

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