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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.

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Predictors of ART-associated TB in a prospective study: Results of the Kericho IRIS Study

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  1. 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

  2. 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

  3. Participant Characteristics at Baseline

  4. 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%)

  5. 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.

  6. 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

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