Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV meningitis a potentially life threatening manifestation 英文参考文献.docVIP

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Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV meningitis a potentially life threatening manifestation 英文参考文献.doc

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Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV meningitis a potentially life threatening manifestation 英文参考文献

Agarwaletal.AIDSResearchandTherapy2012,9:17 /content/9/1/17 SHORT REPORT OpenAccess Tuberculosisassociatedimmunereconstitution inflammatorysyndromeinpatientsinfectedwith HIV:meningitisapotentiallylifethreatening manifestation UpasnaAgarwal1*,AmitabhKumar1,DigamberBehera1,MartynAFrench2andPatriciaPrice2 Abstract Background:Tuberculosis(TB)isthemostcommoncoinfectioninHIV-infectedpersonsinIndia,requiring concomitantadministrationofantiTBandantiretroviraltherapies.Paradoxicalworseningoftuberculosisafter anti-retroviraltherapy(ART)initiationisfrequentlyseen. Objective:Tostudythefrequency,clinicalpresentationandoutcomeofparadoxicaltuberculosisassociated immunereconstitutioninflammatorysyndrome(TB-IRIS)inHIVinfectedpatientsinaTBhospitalinNorthIndia. Design:AretrospectivechartreviewofHIV-infectedTBpatientsonanti-tuberculartreatment(ATT)attimeofART initiationovera3yearperiod.Medicalrecordswerereviewedforclinicalmanifestationsandoutcomeinpatients whodevelopedTB-IRIS. Results:514HIV-infectedpatientswereenrolledbetweenJanuary2006andDecember2008.Thirteen(12.6%)of 103patientswhohadreceivedARTandATTsimultaneouslydevelopedparadoxicalTB-IRIS.Clinicalpresentationsof paradoxicalTB-IRISincludednewlymphadenopathy(n=3),increaseinsizeofexistinglymphadenopathy(n=3), worseningofexistingpulmonarylesions(n=2),appearanceofnewpleuraleffusion(n=1)andprolongedhigh gradefever(n=2).FourpatientsdevelopednewtubercularmeningitisasmanifestationofTB-IRIS.Ourcases developedTB-IRISamedianof15daysafterstartingART(IQR15–36).TB-IRISpatientswereolder(35years)than thosewithnoIRIS(P=0.03),butwerenotdistinguishablebyCD4T-cellcount,durationofATTbeforeARTorthe outcomeofTBtreatment.Eight(62%)patientshadacompleterecoverywhile5(38%)patientswithTB-IRISdied,of whichmajority(n=3)hadmeningitis. Conclusions:ParadoxicalTB-IRISisafrequentproblemduringconcomitantATTandARTinHIV-TBcoinfected patientsinnorthIndia.MeningitisisapotentiallylifethreateningmanifestationofTB-IRIS. Keywords:Tuberculosis,HIV,IRIS,Meningitis Introduct