AEGiS-14IAC: Mycobacterium tuberculosis associated immune reconstitution syndrome and HAART in South Africa.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Mycobacterium tuberculosis associated immune reconstitution syndrome and HAART in South Africa.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10242)

Conradie FM, Van der Horst C, Venter WD, Ive PD, Jentsch U, Sanne IM
University of the Witwatersrand, Johannesburg, South Africa

BACKGROUND: Guidelines for HAART in resource poor areas need to consider high tuberculosis rates. In South Africa with a high HIV and TB incidence (600 per 100 000) many patients are co-infected. Fulminant and potentially fatal inflammatory reactions to TB may occur when starting HAART. Simple clinical methods to identify this syndrome are needed.

METHODS: This is a descriptive, retrospective analysis of seven cases of TB immune reconstitution from our unit.

RESULTS: Before starting HAART, the patients were examined by HIV experienced doctors. With one exception, active TB was not clinically suspected. CD4+ counts ranged from 17(2,2%) to 352(16,8%). Onset of symptoms occurred 14-44 days after the initiation of HAART. Three patients had previous TB but two of these had not completed 6 months of treatment due to non-adherence. Only two patients had a CXR as part of a screening procedure before initiating HAART. Both were normal. 6/7 patients were anaemic at baseline. Once clinical symptoms had developed, 6/7 developed an abnormal CXR. All the patients developed a fever. The presentations of TB was acute and fulminant including: 1 meningitis, 1 pulmonary, 4 miliary diagnosed on marrow biopsy or blood culture. All patients started on 4-drug antituberculous therapy including rifampicin and 3/7 patient received steroids. 2 patients died within 3 days of the initiation of antituberculous therapy. HAART was continued in 3 patients with an Efavirenz based regimen.

CONCLUSIONS: TB immune reconstitution syndrome can present with a fulminant presentation. This potentially fatal condition can be suggsted by measuring a temperature 2 to 8 weeks after initiating HAART. In a high TB incidence area, all patients should be seen at 4 week after starting HAART for a physical examination including a temperature measurement. Incomplete TB treatment may predispose to the syndrome. A normal CXR before HAART does not exclude the diagnosis.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Mycobacterium tuberculosis, Tuberculosis, CD4 Lymphocyte Count, HIV Infections, Incidence, Retrospective Studies, South Africa, Greece, Human

020707
B10242