1Resident Physician, Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA
2Associate Professor, Department of Medicine, Kasturba Medical College, affiliated to Manipal Academy of Higher Education, Mangalore, India
3M.B.B.S Intern, Kasturba Medical College, affiliated to Manipal Academy of Higher Education, Mangalore, India
4Associate Professor, Department of Paediatrics, Kasturba Medical College, affiliated to Manipal Academy of Higher Education, Mangalore, India
5M.B.B.S, Student, Kasturba Medical College, affiliated to Manipal Academy of Higher Education, Mangalore, India
*Corresponding Author: Dr. Basavaprabhu Achappa Associate Professor, Department of Internal Medicine, Kasturba Medical College, Mangalore Affiliated to Manipal Academy of Higher Education Phone Number: +919980170480 Email id: bachu1504@gmail.com
Online published on 7 December, 2018.
IRIS remains as a major obstacle in effective administration of antiretroviral therapy. This study primarily focuses on evaluating the frequency of occurrence of TB-IRIS among HIV patients on antiretroviral therapy. Secondly, it focuses on establishing risk factors or predictors in patients developing TB-IRIS and finally this study aims to determine the various clinical outcomes and effect of IRIS development on survival rates among these patient.
This study is retrospective hospital based executed in the ART centre in Mangalore, Karnataka. Diagnosis of TB-IRIS was made as per INSHI consensus case definition provided for resource-limited settings. The Data from January 2008 till September 2012 was evaluated via semi-structured questionnaire. Inclusion Criteria Patients eligible to receive ART and were above the age of 18. Those patients who were non-compliant with treatment or HIV patients no ton ART were excluded from our sample population
A total of 125 patients were included in this study. 37(29.6%) had diagnosed TB before starting the treatment. 6(16.2%) out of the 37 HIV with combined TB patients progressed to paradoxical TB-IRIS when ART drugs were initiated. 88(70.4%) patients did not have active TB when ART was started, among whom 6 patients developed “unmasking” TB-IRIS. 8 (66.7%) out of the 12 patients developed IRIS in a period of three months of initiation of ART rest 4 (33.3%) patients developed after the three month period. 10 (83.33%)out of the 12 patients were male. 5 out of the 6 patients with paradoxical TB-IRIS had extra-pulmonary TB at the time of ART initiation.
Consensus case definition for the resource limited setting is an effective tool in the diagnosis of TB-IRIS. TB-IRIS can be treated conservatively and although not fatal early diagnosis and management can prevent a complicated course of disease.
Tuberculosis, immune reconstitution inflammatory syndrome, HIV/AIDS, antiretroviral treatment, Co-Infection
