Evaluation of paradoxical TB-associated IRIS with the use of standardized case definitions for resource-limited settings

Objective: Standardized case definitions have recently been proposed by the International Network for the Study of HIV-associated immune reconstitution inflammatory syndrome (INSHI; [IRIS]) for use in resource-limited settings. We evaluated paradoxical tuberculosis (TB)-associated IRIS in a large cohort from a TB endemic setting with the use of these case definitions. Design: A retrospective cohort study. Method: We reviewed records from 1250 South African patients who initiated antiretroviral therapy (ART) over a 5-year period. Results: A total of 333 (27%) of the patients in the cohort had prevalent TB at the initiation of ART. Of 54 possible paradoxical TB-associated IRIS cases, 35 fulfilled the INSHI case definitions (11% of TB cases). Conclusions: INSHI-standardized case definitions were used successfully in identifying paradoxical TB-associated IRIS in this cohort and resulted in a similar proportion of TB IRIS cases ( %) as that reported in previous studies from resource-limited settings (8%-l3%). This case definition should be evaluated prospectively.