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The Rainbow of IRIS in HIV Infection July 26, 2012  Fredrick Kirui, MBChB, MMED Kenya Medical Research Institute/Walter Reed Project HIV Program Kericho, Kenya. Predictors of ART-associated TB in a prospective study: Results of the Kericho IRIS Study. IRIS-Kericho.

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predictors of art associated tb in a prospective study results of the kericho iris study

The Rainbow of IRIS in HIV Infection

  • July 26, 2012 

Fredrick Kirui, MBChB, MMED

Kenya Medical Research Institute/Walter Reed Project HIV Program

Kericho, Kenya

Predictors of ART-associated TB

in a prospective study:

Results of the Kericho IRIS Study

iris kericho
IRIS-Kericho

A Cohort Observational Study Evaluating Predictors, Incidence and Immunopathogenesis of Immune Reconstitution Syndrome (IRIS) in HIV-1 Infected Patients with CD4 Count <100 Cells/µL who are Initiating Antiretroviral Therapy

Primary Objectives:

  • To identify baseline predictors of IRIS within 6 months of ART initiation.
  • To evaluate the immunopathogenesis of IRIS with the goal to identify more appropriate therapeutic targets and interventions.

200 volunteers enrolled between February 2009 and June 2010 and followed for 2 years

tb in the iris study
TB in the IRIS Study
  • IRIS Events (37)
    • Majority of IRIS cases observed were TB related (17,46%)
    • Approximately 2/3 were unmasking TB
  • ART associated TB (within 6 months of ART initiation - considered unmasking TB-IRIS per ACTG definition)
    • 31 cases (19%) of participants
    • Mean age=37 years, 59% F
    • At an average of 6 weeks after ART initiation
    • PTB (63%) > extra-pulmonary (25%) > disseminated (12%)
comparison of art associated tb cases with non tb study participants
Comparison of ART-associated TB cases with non-TB study participants
  • Compared to controls TB cases at baseline had:

- Lower Hgb (9.4 vs. 11.3 gm/dL, p=<0.0001) and BMI (17.7 vs. 18.9, p=0.015)

- Higher ESR (74.6 vs. 38.56 mm/hr, p=0.002)

- Higher proportion of CD8+/PD1+ T cells (39.9 vs. 29.%, p=0.007)

*remained significant in regression analysis (p=0.005)

  • - Higher mortality (28% vs 9% p=0.0066)
  • Screening of patients with low CD4 counts and BMI and anemia and high ESR may facilitate earlier TB diagnosis and treatment.
slide7

Asanteni Sana!

IDCRPNIAIDUSMHRPKEMRI/WRP

Brian Agan Irini Sereti Nelson Michael Fred Sawe

Greg Martin Alice Pau Deline Glover Kibet Shikuku

Gregg Roby Jun Tan Deborah Langat

JoAnn Mican Hellen Ngeno

Virginia Sheikh Argwings Miruka

Lazarus Momanyi

Doug Shaffer

IRIS Endpoint Committee: Martyn French, Chair

IRIS Study Volunteers