Clinical Characteristics of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in North Indian Population of HIV/AIDS Patients Receiving HAART
Identifieur interne : 000E91 ( Pmc/Curation ); précédent : 000E90; suivant : 000E92Clinical Characteristics of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in North Indian Population of HIV/AIDS Patients Receiving HAART
Auteurs : Suman Karmakar [Inde] ; Surendra K. Sharma ; Richa Vashishtha [Inde] ; Abhishek Sharma [Bulgarie] ; Sanjay Ranjan [Inde] ; Deepak Gupta [Inde] ; Vishnubhatla Sreenivas [Inde] ; Sanjeev Sinha [Inde] ; Ashutosh Biswas [Inde] ; Vinay Gulati [Inde]Source :
- Clinical and Developmental Immunology [ 1740-2522 ] ; 2010.
Abstract
Url:
DOI: 10.1155/2011/239021
PubMed: 21197457
PubMed Central: 3003953
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Sharma</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Vashishtha, Richa" sort="Vashishtha, Richa" uniqKey="Vashishtha R" first="Richa" last="Vashishtha">Richa Vashishtha</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Sharma, Abhishek" sort="Sharma, Abhishek" uniqKey="Sharma A" first="Abhishek" last="Sharma">Abhishek Sharma</name><affiliation wicri:level="1"><nlm:aff id="I3">University of Medicine, Pleven, Bulgaria</nlm:aff><country xml:lang="fr">Bulgarie</country><wicri:regionArea>University of Medicine, Pleven</wicri:regionArea></affiliation></author><author><name sortKey="Ranjan, Sanjay" sort="Ranjan, Sanjay" uniqKey="Ranjan S" first="Sanjay" last="Ranjan">Sanjay Ranjan</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Gupta, Deepak" sort="Gupta, Deepak" uniqKey="Gupta D" first="Deepak" last="Gupta">Deepak Gupta</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Sreenivas, Vishnubhatla" sort="Sreenivas, Vishnubhatla" uniqKey="Sreenivas V" first="Vishnubhatla" last="Sreenivas">Vishnubhatla Sreenivas</name><affiliation wicri:level="1"><nlm:aff id="I4">Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Sinha, Sanjeev" sort="Sinha, Sanjeev" uniqKey="Sinha S" first="Sanjeev" last="Sinha">Sanjeev Sinha</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Biswas, Ashutosh" sort="Biswas, Ashutosh" uniqKey="Biswas A" first="Ashutosh" last="Biswas">Ashutosh Biswas</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Gulati, Vinay" sort="Gulati, Vinay" uniqKey="Gulati V" first="Vinay" last="Gulati">Vinay Gulati</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21197457</idno><idno type="pmc">3003953</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003953</idno><idno type="RBID">PMC:3003953</idno><idno type="doi">10.1155/2011/239021</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">000E92</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000E92</idno><idno type="wicri:Area/Pmc/Curation">000E91</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000E91</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Clinical Characteristics of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in North Indian Population of HIV/AIDS Patients Receiving HAART</title><author><name sortKey="Karmakar, Suman" sort="Karmakar, Suman" uniqKey="Karmakar S" first="Suman" last="Karmakar">Suman Karmakar</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Sharma, Surendra K" sort="Sharma, Surendra K" uniqKey="Sharma S" first="Surendra K." last="Sharma">Surendra K. Sharma</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Vashishtha, Richa" sort="Vashishtha, Richa" uniqKey="Vashishtha R" first="Richa" last="Vashishtha">Richa Vashishtha</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Sharma, Abhishek" sort="Sharma, Abhishek" uniqKey="Sharma A" first="Abhishek" last="Sharma">Abhishek Sharma</name><affiliation wicri:level="1"><nlm:aff id="I3">University of Medicine, Pleven, Bulgaria</nlm:aff><country xml:lang="fr">Bulgarie</country><wicri:regionArea>University of Medicine, Pleven</wicri:regionArea></affiliation></author><author><name sortKey="Ranjan, Sanjay" sort="Ranjan, Sanjay" uniqKey="Ranjan S" first="Sanjay" last="Ranjan">Sanjay Ranjan</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Gupta, Deepak" sort="Gupta, Deepak" uniqKey="Gupta D" first="Deepak" last="Gupta">Deepak Gupta</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Sreenivas, Vishnubhatla" sort="Sreenivas, Vishnubhatla" uniqKey="Sreenivas V" first="Vishnubhatla" last="Sreenivas">Vishnubhatla Sreenivas</name><affiliation wicri:level="1"><nlm:aff id="I4">Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Sinha, Sanjeev" sort="Sinha, Sanjeev" uniqKey="Sinha S" first="Sanjeev" last="Sinha">Sanjeev Sinha</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Biswas, Ashutosh" sort="Biswas, Ashutosh" uniqKey="Biswas A" first="Ashutosh" last="Biswas">Ashutosh Biswas</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author><author><name sortKey="Gulati, Vinay" sort="Gulati, Vinay" uniqKey="Gulati V" first="Vinay" last="Gulati">Vinay Gulati</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029</wicri:regionArea></affiliation></author></analytic><series><title level="j">Clinical and Developmental Immunology</title><idno type="ISSN">1740-2522</idno><idno type="eISSN">1740-2530</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><italic>Background & Objective</italic>. IRIS is an important complication that occurs during management of HIV-TB coinfection and it poses difficulty in diagnosis. Previous studies have reported variable incidence of IRIS. The present study was undertaken to describe the pattern of TB-associated IRIS using recently proposed consensus case-definitions for TB-IRIS for its use in resource-limited settings. <italic>Methods</italic>. A prospective analysis of ART-naïve adults started on HAART from November, 2008 to May, 2010 was done in a tertiary care hospital in north India. A total 224 patients divided into two groups, one with HIV-TB and the other with HIV alone, were followedup for a minimum period of 3 months. The diagnosis of TB was categorised as ‘‘definitive” and ‘‘probable”. <italic>Results</italic>. Out of a total of 224 patients, 203 completed followup. Paradoxical TB-IRIS occurred in 5 of 123 (4%) HIV-TB patients while 6 of 80 (7.5%) HIV patients developed ART-associated TB. A reduction in plasma viral load was significantly (<italic>P</italic> = .016) associated with paradoxical TB-IRIS. No identifiable risk factors were associated with the development of ART-associated TB. <italic>Conclusion</italic>. The consensus case-definitions are useful tools in the diagnosis of TB-associated IRIS. 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Stone</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eshun Wilson, I" uniqKey="Eshun Wilson I">I Eshun-Wilson</name></author><author><name sortKey="Havers, F" uniqKey="Havers F">F Havers</name></author><author><name sortKey="Nachega, Jb" uniqKey="Nachega J">JB Nachega</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haddow, Lj" uniqKey="Haddow L">LJ Haddow</name></author><author><name sortKey="Moosa, M Ys" uniqKey="Moosa M">M-YS Moosa</name></author><author><name sortKey="Easterbrook, Pj" uniqKey="Easterbrook P">PJ Easterbrook</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brodie, D" uniqKey="Brodie D">D Brodie</name></author><author><name sortKey="Schluger, Nw" uniqKey="Schluger N">NW Schluger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sharma, Sk" uniqKey="Sharma S">SK Sharma</name></author><author><name sortKey="Mohan, A" uniqKey="Mohan 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Dev Immunol</journal-id><journal-id journal-id-type="iso-abbrev">Clin. Dev. Immunol</journal-id><journal-id journal-id-type="publisher-id">CDI</journal-id><journal-title-group><journal-title>Clinical and Developmental Immunology</journal-title></journal-title-group><issn pub-type="ppub">1740-2522</issn><issn pub-type="epub">1740-2530</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21197457</article-id><article-id pub-id-type="pmc">3003953</article-id><article-id pub-id-type="doi">10.1155/2011/239021</article-id><article-categories><subj-group subj-group-type="heading"><subject>Clinical Study</subject></subj-group></article-categories><title-group><article-title>Clinical Characteristics of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in North Indian Population of HIV/AIDS Patients Receiving HAART</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Karmakar</surname><given-names>Suman</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sharma</surname><given-names>Surendra K.</given-names></name><xref ref-type="aff" rid="I1"><sup>1, 2</sup></xref><xref ref-type="aff" rid="I2"></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Vashishtha</surname><given-names>Richa</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sharma</surname><given-names>Abhishek</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ranjan</surname><given-names>Sanjay</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gupta</surname><given-names>Deepak</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sreenivas</surname><given-names>Vishnubhatla</given-names></name><xref ref-type="aff" rid="I4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sinha</surname><given-names>Sanjeev</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Biswas</surname><given-names>Ashutosh</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gulati</surname><given-names>Vinay</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India</aff><aff id="I2"><sup>2</sup>Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India</aff><aff id="I3"><sup>3</sup>University of Medicine, Pleven, Bulgaria</aff><aff id="I4"><sup>4</sup>Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India</aff><author-notes><corresp id="cor1">*Surendra K. Sharma: <email>surensk@gmail.com</email></corresp><fn fn-type="other"><p>Academic Editor: Katalin Andrea Wilkinson</p></fn></author-notes><pub-date pub-type="ppub"><year>2011</year></pub-date><pub-date pub-type="epub"><day>1</day><month>12</month><year>2010</year></pub-date><volume>2011</volume><elocation-id>239021</elocation-id><history><date date-type="received"><day>14</day><month>7</month><year>2010</year></date><date date-type="rev-recd"><day>9</day><month>9</month><year>2010</year></date><date date-type="accepted"><day>31</day><month>10</month><year>2010</year></date></history><permissions><copyright-statement>Copyright © 2011 Suman Karmakar et al.</copyright-statement><copyright-year>2011</copyright-year><copyright-holder>Copyright © 2011 Suman Karmakar et al.</copyright-holder><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p><italic>Background & Objective</italic>. IRIS is an important complication that occurs during management of HIV-TB coinfection and it poses difficulty in diagnosis. Previous studies have reported variable incidence of IRIS. The present study was undertaken to describe the pattern of TB-associated IRIS using recently proposed consensus case-definitions for TB-IRIS for its use in resource-limited settings. <italic>Methods</italic>. A prospective analysis of ART-naïve adults started on HAART from November, 2008 to May, 2010 was done in a tertiary care hospital in north India. A total 224 patients divided into two groups, one with HIV-TB and the other with HIV alone, were followedup for a minimum period of 3 months. The diagnosis of TB was categorised as ‘‘definitive” and ‘‘probable”. <italic>Results</italic>. Out of a total of 224 patients, 203 completed followup. Paradoxical TB-IRIS occurred in 5 of 123 (4%) HIV-TB patients while 6 of 80 (7.5%) HIV patients developed ART-associated TB. A reduction in plasma viral load was significantly (<italic>P</italic> = .016) associated with paradoxical TB-IRIS. No identifiable risk factors were associated with the development of ART-associated TB. <italic>Conclusion</italic>. The consensus case-definitions are useful tools in the diagnosis of TB-associated IRIS. High index of clinical suspicion is required for an early diagnosis.</p></abstract></article-meta></front><floats-group><fig id="fig1" position="float"><label>Figure 1</label><caption><p>Study profile. HIV: human immunodeficiency virus; TB: tuberculosis; IRIS: immune reconstitution inflammatory syndrome; PMLE: progressive multifocal leukoencephalopathy; HZ: herpes zoster; CMV: cytomegalovirus; Crypto: cryptococcal meningitis.</p></caption><graphic xlink:href="CDI2011-239021.001"></graphic></fig><table-wrap id="tab1" position="float"><label>Table 1</label><caption><p>Baseline characteristics of 203 patients with HIV/AIDS.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">HIV-TB (<italic>n</italic> = 123)</th><th align="center" rowspan="1" colspan="1">HIV (<italic>n</italic> = 80)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age (yrs)</td><td align="center" rowspan="1" colspan="1">36 ± 10</td><td align="center" rowspan="1" colspan="1">35 ± 9</td></tr><tr><td align="left" rowspan="1" colspan="1">Sex (% male)</td><td align="center" rowspan="1" colspan="1">80*</td><td align="center" rowspan="1" colspan="1">59*</td></tr><tr><td align="left" rowspan="1" colspan="1">BMI (kg/m<sup>2</sup>)</td><td align="center" rowspan="1" colspan="1">19 ± 4.5</td><td align="center" rowspan="1" colspan="1">19.6 ± 3.8</td></tr><tr><td align="left" rowspan="1" colspan="1">CD4 (cells/<italic>μ</italic>l)</td><td align="center" rowspan="1" colspan="1">137 (72–222)<sup>†</sup></td><td align="center" rowspan="1" colspan="1">198 (93–238)<sup>†</sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Plasma VL (log<sub>10</sub> copies/ml)</td><td align="center" rowspan="1" colspan="1">5.23 (4.79–5.65)</td><td align="center" rowspan="1" colspan="1">5.09 (4.55–5.65)</td></tr></tbody></table><table-wrap-foot><fn><p>BMI: body mass index; VL: viral load</p></fn><fn><p>Age and BMI are presented as mean ± SD; gender as % of male and CD4 cell counts and viral load as median and IQR</p></fn><fn><p>*<italic>P</italic> = .001</p></fn><fn><p><sup>†</sup><italic>P</italic> = .038.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab2" position="float"><label>Table 2</label><caption><p>Detailed description of 123 TB patients in the HIV-TB group.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Type/site of TB</th><th align="center" rowspan="1" colspan="1">HIV-TB group</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">PTB [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">25 (20)*</td></tr><tr><td align="left" rowspan="1" colspan="1">EPTB [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">98 (80)</td></tr><tr><td align="left" rowspan="1" colspan="1">DTB [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">39 (32)</td></tr><tr><td align="left" rowspan="1" colspan="1">Lung + Pleura + mediastinal LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">11 (9)*</td></tr><tr><td align="left" rowspan="1" colspan="1">Pleura + RP/mesenteric LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">6 (5)</td></tr><tr><td align="left" rowspan="1" colspan="1">Lung + pleura [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">4 (3)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ascites + RP/mesenteric LN + mediastinal LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">4 (3)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ascites + hepatosplenomegaly + RP/mesenteric LN + mediastinal LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">3 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Lung + pleura + Ascites + RP/mesenteric LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">3 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ascites + hepatosplenomegaly + mediastinal LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">2 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Lung + pleura + Ascites + hepatosplenomegaly + RP/mesenteric LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">2 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Lung + pleura + Ileocaecal + RP/mesenteric LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">2 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Cervical LN + mediastinal LN + RP/mesenteric LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">2 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Abdomen [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">23 (19)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ascites + RP/mesenteric LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">8 (7)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ascites + hepatosplenomegaly + RP/mesenteric LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">7 (6)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ascites + hepatosplenomegaly [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">4 (3)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ileocaecal + RP/mesenteric LN [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">4 (3)</td></tr><tr><td align="left" rowspan="1" colspan="1">Lymph node [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">16 (13)</td></tr><tr><td align="left" rowspan="1" colspan="1">Cervical [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">10 (8)<sup>†</sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Abdominal [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">4 (3)</td></tr><tr><td align="left" rowspan="1" colspan="1">RP + mesenteric LN</td><td align="center" rowspan="1" colspan="1">2 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">RP LN</td><td align="center" rowspan="1" colspan="1">1 (1)</td></tr><tr><td align="left" rowspan="1" colspan="1">Periportal + mesenteric LN</td><td align="center" rowspan="1" colspan="1">1 (1)</td></tr><tr><td align="left" rowspan="1" colspan="1">Mediastinal [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">2 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Pleural effusion [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">11 (9)</td></tr><tr><td align="left" rowspan="1" colspan="1">CNS [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">6 (5)</td></tr><tr><td align="left" rowspan="1" colspan="1">Meningitis [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">3 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Tuberculoma [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">2 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Meningitis + Tuberculoma [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">1 (1)</td></tr><tr><td align="left" rowspan="1" colspan="1">MTB [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">2 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Pott's spine [<italic>n</italic>(%)]</td><td align="center" rowspan="1" colspan="1">1 (1)</td></tr></tbody></table><table-wrap-foot><fn><p>PTB: pulmonary tuberculosis; EPTB: extra pulmonary tuberculosis; RP: retroperitoneal; LN: lymph nodes; CNS: central nervous system; DTB: disseminated tuberculosis; MTB: military tuberculosis</p></fn><fn><p>EPTB is presented as % of TB; Types of EPTB as % of EPTB; Subtypes of EPTB types as % of EPTB along with absolute no. of cases</p></fn><fn><p>*One patient each from these groups developed paradoxical TB-IRIS</p></fn><fn><p><sup>†</sup>Three patients from this group developed paradoxical TB-IRIS.</p></fn></table-wrap-foot></table-wrap><table-wrap-group id="tab3" position="float"><label>Table 3</label><caption><p>(a) Method of “definitive*” TB diagnosis in HIV-TB group. *<italic>Mycobacterium tuberculosis</italic> demonstrated in smear and/or culture and/or TB—polymerase chain reaction (PCR) positive in body fluids. PCR: polymerase chain reaction; BAL: bronchoalveolar lavage; CSF: cerebrospinal fluid; LN: lymph node. <sup>†</sup>In 25 cases fine needle aspiration was done, 12 of these showed <italic>Mycobacterium tuberculosis. </italic><sup>‡</sup>One patient from this group developed paradoxical TB-IRIS. <sup>§</sup>One patient from this group developed paradoxical TB-IRIS. (b) Method of “probable*” TB diagnosis in HIV-TB group. *Specimens for smear or culture or PCR for <italic>Mycobacterium tuberculosis</italic> negative or could not be obtained. <sup>†</sup>High resolution or contrast-enhanced computed tomography (CECT) of chest showing—centrilobular nodules with tree-in-bud appearance, miliary nodules, thick walled cavities, enlarged mediastinal lymph nodes with central hypodensities and peripheral rim enhancement suggestive of necrosis; CECT of abdomen showing enlarged liver or spleen with multiple hypodensities suggestive of granulomas or abscesses, matted bowel loops, thickening of terminal ileum and caecum, enlarged necrotic mesenteric or retroperitoneal lymph nodes; CECT and/or magnetic resonance imaging (MRI) of brain showing basal meningitis and/or multiple ring enhancing lesion suggestive of tuberculomas; MRI of spine showing loss of intervertebral space with destruction of vertebral bodies with or without paravertebral abscesses. <sup>‡</sup>Elevated protein, predominantly lymphocytes and high adenosine deaminase level. <sup>§</sup>FNAC or biopsy showing granulomas with caseation necrosis. <sup>¶,<italic>||</italic></sup>,**One patient each from these groups developed paradoxical TB-IRIS.</p></caption><table-wrap id="tab3a" position="anchor"><caption><p>(a) </p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" colspan="1">Specimen type</th><th align="center" colspan="4" rowspan="1">Test (positive/performed)</th></tr><tr><th align="center" rowspan="1" colspan="1">Smear</th><th align="center" rowspan="1" colspan="1">Culture</th><th align="center" rowspan="1" colspan="1">TB-PCR</th><th align="center" rowspan="1" colspan="1">Overall</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Sputum</td><td align="center" rowspan="1" colspan="1">12<sup>‡</sup>/25</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">12</td></tr><tr><td align="left" rowspan="1" colspan="1">BAL</td><td align="center" rowspan="1" colspan="1">0/4</td><td align="center" rowspan="1" colspan="1">2/4</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1">Pleural fluid</td><td align="center" rowspan="1" colspan="1">0/39</td><td align="center" rowspan="1" colspan="1">0/39</td><td align="center" rowspan="1" colspan="1">9/39</td><td align="center" rowspan="1" colspan="1">9</td></tr><tr><td align="left" rowspan="1" colspan="1">Ascitic fluid</td><td align="center" rowspan="1" colspan="1">0/28</td><td align="center" rowspan="1" colspan="1">0/28</td><td align="center" rowspan="1" colspan="1">6/28</td><td align="center" rowspan="1" colspan="1">6</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF</td><td align="center" rowspan="1" colspan="1">0/6</td><td align="center" rowspan="1" colspan="1">2/6</td><td align="center" rowspan="1" colspan="1">3/6</td><td align="center" rowspan="1" colspan="1">3</td></tr><tr><td align="left" rowspan="1" colspan="1">Bone marrow aspirate</td><td align="center" rowspan="1" colspan="1">0/2</td><td align="center" rowspan="1" colspan="1">2/2</td><td align="center" rowspan="1" colspan="1">2/2</td><td align="center" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1">LN aspirate</td><td align="center" rowspan="1" colspan="1">14<sup>§</sup>/27<sup>†</sup></td><td align="center" rowspan="1" colspan="1">2/2</td><td align="center" rowspan="1" colspan="1">2/2</td><td align="center" rowspan="1" colspan="1">14</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Total</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">48</td></tr></tbody></table></table-wrap><table-wrap id="tab3b" position="anchor"><caption><p>(b) </p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Characteristic findings</th><th align="center" rowspan="1" colspan="1">No. present</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">(i) Radiological<sup>†</sup></td><td align="center" rowspan="1" colspan="1">75<sup>¶,<italic>||</italic>,</sup>**</td></tr><tr><td align="left" rowspan="1" colspan="1">(ii) Body fluids<sup>‡</sup></td><td align="center" rowspan="1" colspan="1">39</td></tr><tr><td align="left" rowspan="1" colspan="1"> Pleural effusion</td><td align="center" rowspan="1" colspan="1">22<sup>¶</sup></td></tr><tr><td align="left" rowspan="1" colspan="1"> Ascites</td><td align="center" rowspan="1" colspan="1">14</td></tr><tr><td align="left" rowspan="1" colspan="1"> CSF</td><td align="center" rowspan="1" colspan="1">3</td></tr><tr><td align="left" rowspan="1" colspan="1">(iii) Histopathological<sup>§</sup></td><td align="center" rowspan="1" colspan="1">3<sup><italic>||</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">(i) + (ii) + (iii)</td><td align="center" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1">(i) + (ii)</td><td align="center" rowspan="1" colspan="1">38<sup>¶</sup></td></tr><tr><td align="left" rowspan="1" colspan="1">(i) + (iii)</td><td align="center" rowspan="1" colspan="1">2<sup><italic>||</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">(i)</td><td align="center" rowspan="1" colspan="1">34**</td></tr><tr><td align="center" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Total</td><td align="center" rowspan="1" colspan="1">75</td></tr></tbody></table></table-wrap></table-wrap-group><table-wrap id="tab4" position="float"><label>Table 4</label><caption><p>Diagnosis of paradoxical TB-IRIS according to consensus case-definition.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" colspan="1">Sl. no.</th><th align="center" colspan="2" rowspan="1">TB</th><th align="left" rowspan="2" colspan="1">TB-IRIS</th><th align="center" colspan="2" rowspan="1">Clinical criteria*</th></tr><tr><th align="left" rowspan="1" colspan="1">Site</th><th align="left" rowspan="1" colspan="1">Category</th><th align="left" rowspan="1" colspan="1">Major</th><th align="left" rowspan="1" colspan="1">Minor </th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">(1)</td><td align="left" rowspan="1" colspan="1">DTB (Lung + Pleura + mediastinal LN)</td><td align="left" rowspan="1" colspan="1">Probable</td><td align="left" rowspan="1" colspan="1">DTB (Lung + Pleura + mediastinal + RP/mesenteric LN)</td><td align="left" rowspan="1" colspan="1">New LN</td><td align="left" rowspan="1" colspan="1">Worsening constitutional symptoms (fever, weight loss, etc.) </td></tr><tr><td align="center" colspan="6" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(2)</td><td align="left" rowspan="1" colspan="1">LNTB (cervical)</td><td align="left" rowspan="1" colspan="1">Definitive</td><td align="left" rowspan="1" colspan="1">DTB (cervical + mediastinal + RP/mesenteric LN)</td><td align="left" rowspan="1" colspan="1">New LN</td><td align="left" rowspan="1" colspan="1">Worsening constitutional symptoms</td></tr><tr><td align="center" colspan="6" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(3)</td><td align="left" rowspan="1" colspan="1">LNTB (cervical)</td><td align="left" rowspan="1" colspan="1">Probable</td><td align="left" rowspan="1" colspan="1">DTB (cervical + mediastinal + RP/mesenteric LN)</td><td align="left" rowspan="1" colspan="1">New LN</td><td align="left" rowspan="1" colspan="1">Worsening constitutional symptoms</td></tr><tr><td align="center" colspan="6" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(4)</td><td align="left" rowspan="1" colspan="1">PTB</td><td align="left" rowspan="1" colspan="1">Definitive</td><td align="left" rowspan="1" colspan="1">PTB</td><td align="left" rowspan="1" colspan="1">Worsening CXR</td><td align="left" rowspan="1" colspan="1">Worsening constitutional symptoms<break></break>Worsening respiratory symptoms (cough, dyspnoea, etc.) </td></tr><tr><td align="center" colspan="6" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(5)</td><td align="left" rowspan="1" colspan="1">LNTB (cervical)</td><td align="left" rowspan="1" colspan="1">Probable</td><td align="left" rowspan="1" colspan="1">LNTB (cervical)</td><td align="left" rowspan="1" colspan="1">New & enlarging LN</td><td align="left" rowspan="1" colspan="1">Worsening constitutional symptoms</td></tr></tbody></table><table-wrap-foot><fn><p>PTB: pulmonary tuberculosis; RP: retroperitoneal; LN: lymph nodes; DTB: disseminated tuberculosis</p></fn><fn><p>*“Antecedent requirements” and “Alternative explanations for clinical deterioration” criteria were fulfilled in all the cases.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab5" position="float"><label>Table 5</label><caption><p>Comparison characteristics between patients with and without TB-IRIS in 123 patients with HIV-TB.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">No. TB-IRIS</th><th align="center" rowspan="1" colspan="1">TB-IRIS</th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1"> (<italic>n</italic> = 118)</th><th align="center" rowspan="1" colspan="1">(<italic>n</italic> = 5) </th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age (yrs)</td><td align="center" rowspan="1" colspan="1">37 ± 10</td><td align="center" rowspan="1" colspan="1">31 ± 7</td></tr><tr><td align="left" rowspan="1" colspan="1">Sex (% male)</td><td align="center" rowspan="1" colspan="1">80</td><td align="center" rowspan="1" colspan="1">80</td></tr><tr><td align="left" rowspan="1" colspan="1">BMI (kg/m<sup>2</sup>)</td><td align="center" rowspan="1" colspan="1">19 ± 5</td><td align="center" rowspan="1" colspan="1">18 ± 3</td></tr><tr><td align="left" rowspan="1" colspan="1">ATT-ART (days)</td><td align="center" rowspan="1" colspan="1">32 (21–70)</td><td align="center" rowspan="1" colspan="1">20 (18–27)</td></tr><tr><td align="left" rowspan="1" colspan="1">CD4 (cells/<italic>μ</italic>l)</td><td align="center" rowspan="1" colspan="1">136 (70–225.75)</td><td align="center" rowspan="1" colspan="1">167 (118–193)</td></tr><tr><td align="left" rowspan="1" colspan="1">Increase in CD4</td><td align="center" rowspan="2" colspan="1">89 (32.25–144.75)</td><td align="center" rowspan="2" colspan="1">229 (61–283)</td></tr><tr><td align="left" rowspan="1" colspan="1">(cells/<italic>μ</italic>l)</td></tr><tr><td align="left" rowspan="1" colspan="1">Increase in CD4 (%)</td><td align="center" rowspan="1" colspan="1">57.6 (24–181)</td><td align="center" rowspan="1" colspan="1">119 (63.5–207)</td></tr><tr><td align="left" rowspan="1" colspan="1">VL (log<sub>10</sub> copies/ml)</td><td align="center" rowspan="1" colspan="1">5.21 (4.76–5.65)</td><td align="center" rowspan="1" colspan="1">5.49 (5.18–5.63)</td></tr><tr><td align="left" rowspan="1" colspan="1">Decrease in VL</td><td align="center" rowspan="2" colspan="1">5.19 (4.76–5.63)</td><td align="center" rowspan="2" colspan="1">5.49 (5.18–5.63)</td></tr><tr><td align="left" rowspan="1" colspan="1">(log<sub>10</sub> copies/ml)</td></tr><tr><td align="left" rowspan="1" colspan="1">Decrease in VL (%)</td><td align="center" rowspan="1" colspan="1">99.58 (98.85–99.9)*</td><td align="center" rowspan="1" colspan="1">99.93 (99.91–99.97)*</td></tr></tbody></table><table-wrap-foot><fn><p>BMI: body mass index; ATT: antituberculosis treatment; ART: antiretroviral treatment; VL: viral load</p></fn><fn><p>Age and BMI are presented as mean ± SD; gender as % of male; EPTB as % of TB; DTB as % of EPTB and ATT-ART gap, CD4 cell counts and viral load as median and IQR</p></fn><fn><p>*<italic>P</italic> = .016.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab6" position="float"><label>Table 6</label><caption><p>Comparison of characteristics between patients with and without ART-associated TB in 80 patients with HIV.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">No TB</th><th align="center" rowspan="1" colspan="1">ART-associated TB</th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">(<italic>n</italic> = 74)</th><th align="center" rowspan="1" colspan="1">(<italic>n</italic> = 6)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age (yrs)</td><td align="center" rowspan="1" colspan="1">35 ± 9</td><td align="center" rowspan="1" colspan="1">35 ± 15</td></tr><tr><td align="left" rowspan="1" colspan="1">Sex (% male)</td><td align="center" rowspan="1" colspan="1">60</td><td align="center" rowspan="1" colspan="1">50</td></tr><tr><td align="left" rowspan="1" colspan="1">BMI (kg/m<sup>2</sup>)</td><td align="center" rowspan="1" colspan="1">19.7 ±3.8</td><td align="center" rowspan="1" colspan="1">19.4 ± 4</td></tr><tr><td align="left" rowspan="1" colspan="1">CD4 (cells/<italic>μ</italic>l)</td><td align="center" rowspan="1" colspan="1">200 (94.25–242)</td><td align="center" rowspan="1" colspan="1">132 (57.25–182.75)</td></tr><tr><td align="left" rowspan="1" colspan="1">Increase in CD4</td><td align="center" rowspan="2" colspan="1">88 (27.25–149.75)</td><td align="center" rowspan="2" colspan="1">161 (129–316)</td></tr><tr><td align="left" rowspan="1" colspan="1">(cells/<italic>μ</italic>l)</td></tr><tr><td align="left" rowspan="1" colspan="1">Increase in CD4 (%)</td><td align="center" rowspan="1" colspan="1">46 (11.5–126.5)</td><td align="center" rowspan="1" colspan="1">160 (72–369)</td></tr><tr><td align="left" rowspan="1" colspan="1">VL (log<sub>10</sub> copies/ml)</td><td align="center" rowspan="1" colspan="1">5.09 (4.54–5.65)</td><td align="center" rowspan="1" colspan="1">5.28 (4.95–5.51)</td></tr><tr><td align="left" rowspan="1" colspan="1">Decrease in VL</td><td align="center" rowspan="2" colspan="1">5.08 (4.5–5.57)</td><td align="center" rowspan="2" colspan="1">5.13 (4.87–5.39)</td></tr><tr><td align="left" rowspan="1" colspan="1">(log<sub>10</sub> copies/ml)</td></tr><tr><td align="left" rowspan="1" colspan="1">Decrease in VL (%)</td><td align="center" rowspan="1" colspan="1">99.58 (98.79–99.9)</td><td align="center" rowspan="1" colspan="1">99.91 (99.84–99.93)</td></tr></tbody></table><table-wrap-foot><fn><p>BMI: body mass index; VL: viral load</p></fn><fn><p>Age and BMI are presented as mean ± SD; gender as % of male and CD4 cell counts and viral load as median and IQR</p></fn><fn><p>There was no statistically significant difference.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab7" position="float"><label>Table 7</label><caption><p>Comparison of characteristics between HIV-TB patients without and with TB-IRIS and HIV patients with ART associated TB.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">No TB-IRIS</th><th align="center" rowspan="1" colspan="1">TB-IRIS</th><th align="center" rowspan="1" colspan="1">ART-associated TB</th></tr><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">(<italic>n</italic> = 118)</th><th align="center" rowspan="1" colspan="1">(<italic>n</italic> = 5)</th><th align="center" rowspan="1" colspan="1">(<italic>n</italic> = 6)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age (yrs)</td><td align="center" rowspan="1" colspan="1">37 ± 10</td><td align="center" rowspan="1" colspan="1">31 ± 7</td><td align="center" rowspan="1" colspan="1">35 ± 15</td></tr><tr><td align="left" rowspan="1" colspan="1">Sex (% male)</td><td align="center" rowspan="1" colspan="1">80</td><td align="center" rowspan="1" colspan="1">80</td><td align="center" rowspan="1" colspan="1">50</td></tr><tr><td align="left" rowspan="1" colspan="1">BMI (kg/m<sup>2</sup>)</td><td align="center" rowspan="1" colspan="1">19 ± 5</td><td align="center" rowspan="1" colspan="1">18 ± 3</td><td align="center" rowspan="1" colspan="1">19.4 ± 4</td></tr><tr><td align="left" rowspan="1" colspan="1">ATT-ART (days)</td><td align="center" rowspan="1" colspan="1">32 (21–70)</td><td align="center" rowspan="1" colspan="1">20 (18–27)</td><td align="center" rowspan="1" colspan="1">—</td></tr><tr><td align="left" rowspan="1" colspan="1">ART-IRIS (days)</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">73 (6–84)</td><td align="center" rowspan="1" colspan="1">37 (7–88)</td></tr><tr><td align="left" rowspan="1" colspan="1">CD4 (cells/<italic>μ</italic>l)</td><td align="center" rowspan="1" colspan="1">136 (70–225.75)</td><td align="center" rowspan="1" colspan="1">167 (118–193)</td><td align="center" rowspan="1" colspan="1">132 (57.25–182.75)</td></tr><tr><td align="left" rowspan="1" colspan="1">Increase in CD4 (cells/<italic>μ</italic>l)</td><td align="center" rowspan="1" colspan="1">89 (32.25–144.75)</td><td align="center" rowspan="1" colspan="1">229 (61–283)</td><td align="center" rowspan="1" colspan="1">161 (129–316)</td></tr><tr><td align="left" rowspan="1" colspan="1">Increase in CD4 (%)</td><td align="center" rowspan="1" colspan="1">57.6 (24–181)</td><td align="center" rowspan="1" colspan="1">119 (63.5–207)</td><td align="center" rowspan="1" colspan="1">160 (72–369)</td></tr><tr><td align="left" rowspan="1" colspan="1">VL (log<sub>10</sub> copies/ml)</td><td align="center" rowspan="1" colspan="1">5.21 (4.76–5.65)</td><td align="center" rowspan="1" colspan="1">5.49 (5.18–5.63)</td><td align="center" rowspan="1" colspan="1">5.28 (4.95–5.51)</td></tr><tr><td align="left" rowspan="1" colspan="1">Decrease in VL (log<sub>10</sub> copies/ml)</td><td align="center" rowspan="1" colspan="1">5.19 (4.76–5.63)</td><td align="center" rowspan="1" colspan="1">5.49 (5.18–5.63)</td><td align="center" rowspan="1" colspan="1">5.13 (4.87–5.39)</td></tr><tr><td align="left" rowspan="1" colspan="1">Decrease in VL (%)</td><td align="center" rowspan="1" colspan="1">99.58 (98.85–99.9)</td><td align="center" rowspan="1" colspan="1">99.93 (99.91–99.97)</td><td align="center" rowspan="1" colspan="1">99.91 (99.84–99.93)</td></tr></tbody></table><table-wrap-foot><fn><p>BMI: body mass index; ATT: antituberculosis treatment; ART: antiretroviral treatment; VL: viral load</p></fn><fn><p>Age and BMI are presented as mean ± SD; gender as % of male and ATT-ART gap, ART-IRIS gap, CD4 cell counts and viral load as median and IQR.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab8" position="float"><label>Table 8</label><caption><p>Description of TB in patients with TB-IRIS (at the time of IRIS) and ART-associated TB.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">Paradoxical TB-IRIS (<italic>n</italic> = 5)*</th><th align="left" rowspan="1" colspan="1">ART-associated TB (<italic>n</italic> = 6)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">PTB [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">5</td></tr><tr><td align="left" rowspan="1" colspan="1">EPTB [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1">DTB [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">—</td></tr><tr><td align="left" rowspan="1" colspan="1">Lung + Pleura + mediastinal LN + RP/mesenteric LN [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">—</td></tr><tr><td align="left" rowspan="1" colspan="1">Cervical LN + mediastinal LN + RP/mesenteric LN [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">—</td></tr><tr><td align="left" rowspan="1" colspan="1">Lymph node [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1">Cervical [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">1</td></tr></tbody></table><table-wrap-foot><fn><p>PTB: pulmonary tuberculosis; EPTB: extrapulmonary tuberculosis; DTB: disseminated tuberculosis; LN: lymph node</p></fn><fn><p>EPTB, types of EPTB and subtypes of EPTB types presented in absolute no. of cases</p></fn><fn><p>*Three of the 5 patients with paradoxical IRIS had cervical TB lymphadenopathy at presentation while one had disseminated and the other had pulmonary TB. After being started on ART, one with cervical TB lymphadenopathy developed enlargement of the previously existing lymph nodes along with appearance of new nodes in the neck; other two with cervical TB lymphadenopathy developed disseminated TB; in one with disseminated TB (lung, pleura and mediastinum) the disease became more extensive (with abdominal involvement); and one with pulmonary TB developed new chest infiltrates with increased bacillary load in the sputum.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab9" position="float"><label>Table 9</label><caption><p>Method of TB diagnosis in patients with TB-IRIS (at the time of IRIS) and ART-associated TB.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" colspan="1">Specimen type</th><th align="center" colspan="4" rowspan="1">Test (positive/performed)</th></tr><tr><th align="center" rowspan="1" colspan="1">Smear</th><th align="center" rowspan="1" colspan="1">Culture</th><th align="center" rowspan="1" colspan="1">TB-PCR</th><th align="center" rowspan="1" colspan="1">Overall</th></tr></thead><tbody><tr><td align="center" colspan="5" rowspan="1">TB-IRIS</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Sputum</td><td align="center" rowspan="1" colspan="1">1/1</td><td align="center" rowspan="1" colspan="1">1/1</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1">LN aspirate</td><td align="center" rowspan="1" colspan="1">4/4</td><td align="center" rowspan="1" colspan="1">4/4</td><td align="center" rowspan="1" colspan="1">4/4</td><td align="center" rowspan="1" colspan="1">4 </td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Total</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">5</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="center" colspan="5" rowspan="1">ART-associated TB</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Sputum</td><td align="center" rowspan="1" colspan="1">4/5</td><td align="center" rowspan="1" colspan="1">5/5</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">5</td></tr><tr><td align="left" rowspan="1" colspan="1">LN aspirate*</td><td align="center" rowspan="1" colspan="1">1/1</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">1 </td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Total</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">6</td></tr></tbody></table><table-wrap-foot><fn><p>PCR: polymerase chain reaction; LN: lymph node</p></fn><fn><p>*Fine needle aspiration was done in this case and the specimen also showed necrotizing granulomas on histopathological examination.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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