Deciphering TB-IRIS in HIV Patients: A Comprehensive Clinical and Microbiological Analysis

Priyanka G, Tripathi AK, Shikha G, Singh KP and Abhishek G

Published on: 2024-11-12

Abstract

Tuberculosis (TB) and HIV co-infection presents a complex clinical challenge, with TB-IRIS emerging as a significant complication following antiretroviral therapy (ART) initiation. This prospective cohort study included 400 HIV patients from the ART centre at KGMU, Lucknow, India. Patients were categorized based on TB status and monitored for the development of TB-IRIS following ART initiation. Clinical data, CD4 counts, and microbiological analyses, including drug susceptibility testing, were conducted. TB-IRIS was classified as paradoxical or unmasking, and outcomes were assessed over a one-year period. Among 400 patients, 38 (9.5%) developed TB-IRIS, with 31 (81.6%) presenting unmasking TB-IRIS and 7 (18.4%) paradoxical TB-IRIS. Tubercular meningitis (TBM) was the most common manifestation (47.3%), followed by pulmonary TB (29.0%). The incidence of TB-IRIS was higher (15.4%) in patients who initiated ART within one month of starting anti-TB therapy (ATT) compared to those who started ART later (5.5%). A lower baseline CD4 count (<100 cells/µL) was significantly associated with a higher risk of TB-IRIS (p=0.003). The drug resistance analysis revealed 27.2% resistance to both isoniazid and rifampicin. Steroid therapy was administered to 13% of TB-IRIS patients. The overall cure/ improvement rate was 71%, while the mortality rate was 23.6%. This study highlights the predominance of unmasking TB-IRIS in HIV patients initiating ART, particularly those with low baseline CD4 count and early ART initiation post-ATT. The significant drug resistance observed underscores the need for robust diagnostic and treatment protocols. Improved management strategies are essential to enhance clinical outcomes in TB-IRIS patients.