Characteristics of Paradoxical Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome and its Influence on Tuberculosis Treatment Outcomes in Persons Living with HIV.

Abstract Objective Tuberculosis (TB)-associated immune reconstitution inflammatory Syndrome (IRIS) influence on TB treatment outcomes and its risk factors were investigated among persons with HIV coinfected with TB. Methods Newly diagnosed, culture-confirmed, pulmonary TB patients with HIV, enrolled in a clinical trial (NCT00933790) were retrospectively analyzed for IRIS occurrence. Risk factors and TB outcomes (for up to 18 months after initiation of anti-TB treatment [ATT]) were compared between patients experiencing IRIS (IRIS group) and those who did not (Non-IRIS group). Results TB-IRIS occurred in 28% (82/292) of patients. Significant baseline risk factors predisposing to TB-IRIS occurrence in univariate analysis were lower CD4+ T-cell count, CD4/CD8 ratio, hemoglobin levels, as well as presence of extra-pulmonary TB focus and higher HIV viral load, with the last two retaining significance in the multivariate analysis. After 2 months of ATT commencement, sputum smear conversion was documented in 45/80 (56.2%) vs. 124/194 (63.9%) (p = 0.23), culture conversion was 75/80 (93.7%) vs. 178/194 (91.7%) (p = 0.57) and the median decline in viral load (log10copies/mm3) being 2.7 in the IRIS vs. 1.1 in the non-IRIS groups (p  Conclusions TB–IRIS occurs frequently in persons with advanced HIV infection and in those presenting with extra-pulmonary TB lesions, without influencing subsequent TB treatment outcomes.