Late-outcomes of TB-IRIS

William Worodria, MBChB, MMed, PhDSenior EDCTP Fellow

Infectious Disease Institute, Kampala, Uganda Mulago Hospital & Complex, Kampala, Uganda

The Rainbow of IRIS in HIV, 26th July 2012

Study objective

To determine if there are differences in treatment outcomes between TB-HIV co-infected patients with and without TB-IRIS:• CD4 changes with treatment•Mortality• Loss to follow up

The Rainbow of IRIS in HIV, 26th July 2012

Methodology Site: Mulago National TB treatment centre Design: Case-control design. Inclusion criteria:– ART naïve adult patients co-infected with TB-HIV

started on HAART (CD4<250) Exclusion criteria:– No treatment supporter– Severe liver/renal abnormalities

Cases: patients with TB-IRIS Controls: patients without TB-IRIS

-matched by baseline CD4 count (1:2)The Rainbow of IRIS in HIV,

26th July 2012

ResultsFrom December 2007 - July 2010, we enrolled 254 patients with TB-HIV starting ART

We identified:–61 cases of TB-IRIS and–122 controls (no TB-IRIS)

The Rainbow of IRIS in HIV, 26th July 2012

The Rainbow of IRIS in HIV, 26th July 2012

0tan28a5

66028

0tan5a5

6605

0tan11a5

66011

0tan17a5

66017

0tan23a5

66023

0tan7a5

66070tan28a566028

0tan19a566019

0tan10a566010

0tan1a56601

0tan21a566021

0tan12a566012

0tan3a56613

0tan23a566123

TB-IRISno TB-IRIS

Months of follow up

CD4

coun

ts (

cells

/µL)

Median CD4 counts of patients co-infected with TB-HIV on antiretroviral therapy

Treatment outcomesMortality:

6 (10%) patients with TB-IRIS died vs 18 (15%) without TB-IRIS

ORmortality = 0.60, 95% CI 0.21-1.70, (p= 0.34)

Loss to Follow up: 5 (8.2%) patients with TB-IRIS vs 10 (8.2%) without were lost to follow up

ORloss2fu = 1.00, 95% CI 0.33- 3.04, (p=1.00)

The Rainbow of IRIS in HIV, 26th July 2012

Conclusion

TB-IRIS in this study with a small sample size had no impact on outcomes

The Rainbow of IRIS in HIV, 26th July 2012

Acknowledgments

The Rainbow of IRIS in HIV, 26th July 2012

Prof. R Colebunders

Joseph Sempa

All patients

M-MJAP