Meningitis as fatal complication of TB-IRIS with HIV in north India
Future studies in areas with high prevalence of M. tuberculosis infection should address the issue of how patients at risk of developing paradoxical central nervous system TB-IRIS might be identified.
Immune reconstitution inflammatory syndrome (IRIS) proved a frequent complication in tuberculosis patients starting antiretroviral therapy (ART) in north India. Meningitis was a common component of TB-IRIS and was often fatal.
Tuberculosis is the most frequent coinfection in HIV-positive people in many countries, including India. TB-IRIS often develops when ART begins in patients with TB coinfection. Researchers undertook this retrospective chart review to assess the frequency, clinical presentation, and outcome of paradoxical TB-IRIS in HIV-positive patients in a TB hospital in New Delhi.
The study involved 514 HIV-positive people enrolled between January 2006 and December 2008. Of 103 patients who received ART and TB therapy simultaneously, paradoxical TB-IRIS developed in 13 (12.6%).
TB-IRIS developed a median of 15 days after people started ART (interquartile range [IQR] 15 to 36). TB-IRIS patients were older than those without TB-IRIS but could not be distinguished by CD4 count, duration of TB therapy before ART, or TB treatment outcome.
Clinical manifestations of TB-IRIS included new lymphadenopathy in 3 patients, increased size of existing lymphadenopathy in 3, worsening of existing pulmonary lesions in 2, new pleural effusion in 1, and prolonged high-grade fever in 2.
Meningitis developed in 4 of 13 patients (31%) with TB-IRIS. While 8 patients with TB-IRIS had a full recovery, 5 died, including 3 of 4 with meningitis.
“Meningitis is a potentially life threatening manifestation of TB-IRIS,” the authors conclude. Therefore they propose that “future studies in areas with high prevalence of M. tuberculosis infection should . . . address the issue of how patients at risk of developing paradoxical central nervous system TB-IRIS might be identified.”
By Mark Mascolini
Source: Upasna Agarwal, Amitabh Kumar, Digamber Behera, Martyn French, Patricia Price. Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV: meningitis a potentially life threatening manifestation. AIDS Research and Therapy. 2012; 9: 17.
Complete article provided by AIDS Research and Therapy, an open-access journal