Antiretroviral Therapy and Tuberculosis: What's the Connection and What's the Way Forward?
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ABSTRACT: Immune reconstitution inflammatory syndrome occurs in a subset of HIV-infected individuals as the immune system recovers secondary to antiretroviral therapy. An exaggerated and uncontrolled inflammatory response to antigens of viable or nonviable organisms is characteristic, with clinical deterioration despite improvement in laboratory indicators. We describe a fatal case of Mycobacterium tuberculosis meningitis immune reconstitution inflammatory syndrome in an HIV-infected child and review the literature.The Pediatric Infectious Disease Journal 08/2012; 32(2). DOI:10.1097/INF.0b013e31827031aa · 3.14 Impact Factor
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ABSTRACT: Objective: To determine tuberculosis (TB) incidence and evaluate TB risk in adults after one or more years of use of the impact of combination antiretroviral therapy (cART) one-year response on TB risk. Design: Retrospective cohort study in Jos, Nigeria. Methods: We studied a cohort of HIV-infected adults treated with cART for at least one year. Based on immunologic and virologic responses to cART, patients were categorized into four groups: CD4-Tcell count ≥ 350 cells / mm3 and HIV-1 RNA level ≤ 400 copies/ml (Group 1); CD4-Tcell count ≥ 350 cells /mm3 and HIV-1 RNA level > 400 copies/ml (Group 2); CD4-Tcell counts < 350 cells/ mm3 and HIV-1 RNA level≤400 copies/ml (Group 3) and CD4T-cell counts < 350 cells/mm3 and HIV-1 RNA level >400 copies/ml (Group 4). Time to incident TB for the four groups was analyzed using the Kaplan-Meier method. Cox regression models were used to evaluate predictors of incident TB. Results: In this cohort of 5,093 HIV infected adults, of which 68.4% were female, with mean age 35.1 years (standard deviation 9.1 years), we observed 98 cases of incident TB during four years and three months of follow-up. Overall TB incidence rate was 8.7 cases / 1000 PYFU. Adjusted hazards for incident TB were 2.11 (95% CI 0.97-4.61), 2.05 (95% CI 1.10-3.79) and 3.65(95% CI 1.15-5.06) in group 2, 3 and 4 patients respectively, compared to group 1. Conclusion: Tuberculosis incidence in patients on cART is driven by poor immunologic and/ or virologic response. Optimization of HIV treatment should be prioritized to reduce the burden of TB in this high risk population.AIDS research and human retroviruses 01/2013; DOI:10.1089/AID.2012.0231 · 2.46 Impact Factor