Prognostic factors for immune reconstitution inflammatory syndrome in patients with HIV and tuberculosis during antiretroviral therapy

Antiretroviral therapy (ARVT) promotes the growth of a CD4 lymphocyte subpopulation, which leads to the development of immune reconstitution inflammatory syndrome (IRIS) in a number of patients with late-stage HIV and tuberculosis (TB) coinfection. Early prognostic factors for IRIS should be identified to timely initiate pathogenetic therapy aimed at its relief and ARVT continuation.

Objective. To develop a method for the early diagnosis of IRIS in patients with HIV/TB coinfection during ARVT and to identify criteria for initiating pathogenetic therapy.

Subjects and methods. The investigation enrolled 200 patients with HIV/TB coinfection who were divided into 2 groups: 1) 100 patients who received antituberculosis therapy (ATBT) without ARVT; 2) 100 patients who had combination (ARVT + ATBT) treatment. A control group included 50 healthy volunteers. To determine the prognostic factors for IRIS, all the patients underwent studies of viral load, CD4 lymphocyte levels, plasma lipid profile, and a complete blood count with a differential blood count before and after 1 month of treatment.

Results. In Group 2, the signs of IRIS were detected in 30 (30%) patients; those were absent in 70 (70%) patients at 10-14 days after the start of combination (ARVT + ATBT) therapy. The level of stab neutrophils was significantly higher in patients with the signs of IRIS than in those without IRIS, despite the absence of a difference in viral load and CD4 lymphocyte levels (p>0.05). All the patients with HIV/TB coinfection showed changes in the indicators of the lipid spectrum. However, there were significant differences between the patients with and without IRIS only in the level of triglycerides (TG) (1.4±0.2 and 0.9±0.2 mmol/l, respectively; p<0.001). Timely detoxification therapy for patients with the signs of IRIS (manifestations of intoxication syndrome and elevated TG levels) resulted in the relief of this syndrome, which made it possible to continue ARVT.

Conclusion. The significant increase in the level of TG in patients with the signs of IRIS during ARVT + ATBT allows this indicator to be used as an early laboratory marker of the risk for IRIS to timely prescribe pathogenetic therapy and to continue ARVT, which is important in predicting the disease.