The Immune Reconstitution Inflammatory Syndrome with Tuberculosis: A Common Problem in Ethiopian HIV-Infected Patients Beginning Antiretroviral Therapy

The Immune Reconstitution Inflammatory Syndrome (IRIS) in Ethiopian HIV-infected patients coinfected with tuberculosis (TB) was studied. HIV-infected outpatients initiating antiretroviral therapy (ART) at an HIV clinic in northern Ethiopia from January 2007 through September 2008 were identified (n 1977). Patients with TB-IRIS occurring within 6 months of starting ART (n 143) were compared with a control group of patients with HIV who began ART but did not develop TB-IRIS (n 277). ART was not interrupted in any patient. Eleven (8%) patients with TB-IRIS died. New or ‘‘unmasked’ ’ TB with accompanying IRIS occurred in 132 or 92 % of the cases. Worsening or ‘‘paradoxical’ ’ TB (ie, already known to be present and treated) was accom-panied by IRIS in 11 (8%) patients. There was no significant difference between ‘‘unmasked’ ’ and ‘‘paradoxical’ ’ cases with respect to presentation of disease and outcome. Only a low baseline CD4 count (mean: 102 cells/mL) and a past history of World Health Organization (WHO) Clinical Stage 3 or 4 were associated with TB-IRIS (P <.05). The clinical manifestations of TB-IRIS were diverse, requiring a high index of suspicion. For example, pleural disease occurred in 13 patients, TB lymphadenitis in 17, intra-cranial TB in 9 patients, and disseminated TB in 15 patients. The majority of patients (88%) responded to continuation of ART and TB therapy. Thus, TB-IRIS is common in Ethiopian patients beginning ART, occurring in 7 % of patients initiating antiretroviral therapy