Open AccessParadoxical TB-IRIS in HIV-infected Adults: a Systematic Review and Meta-analysis
Author(s) -
Phiona E. Namale,
Leila Abdullahi,
Stacey Fine,
Monika Kamkuemah,
Robert J. Wilkinson,
Graeme Meintjes
Publication year - 2015
Publication title -
future microbiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.797
H-Index - 82
eISSN - 1746-0921
pISSN - 1746-0913
DOI - 10.2217/fmb.15.9
Subject(s) - meta analysis , medicine , human immunodeficiency virus (hiv) , immune reconstitution inflammatory syndrome , iris (biosensor) , systematic review , virology , medline , antiretroviral therapy , biology , viral load , computer security , biometrics , computer science , biochemistry
Paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) was first described almost two decades ago. We undertook this systematic review and meta-analysis to collate findings across studies that have reported the incidence, clinical features, management and outcomes of paradoxical TB-IRIS. Forty studies that cumulatively reported 1048 paradoxical TB-IRIS cases were included. The pooled estimated incidence among patients with HIV-associated TB initiating antiretroviral therapy was 18% (95% CI: 16-21%). Frequent features were pulmonary and lymph node involvement. Hospitalization occurred in 25% (95% CI: 19-30%). In studies that reported treatment, corticosteroids were prescribed more frequently (38%; 95% CI: 27-48%) than nonsteroidal anti-inflammatory drugs (28%; 95% CI: 2-53%). Case fatality was 7% (95% CI: 4-11%), but death attributed to TB-IRIS occurred in 2% of cases (95% CI: 1-3%).
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