Good news on TB-IRIS treatment

A POSSIBLE breakthrough in the treatment of TB associated immune reconstitution inflammatory syndrome (TB-IRIS), common among HIV-positive patients, has been made by UCT scientists.

To date, there has been no management strategy of preventing TB-IRIS from developing in HIV patients, which causes enlarged lymph nodes.

The research by UCT Professor Graeme Meintjes, which was done in collaboration with researchers at the Institute of Tropical Medicine (ITM) in Antwerp, Belgium, showed that a moderate-dose of immune suppressant prednisone reduces the risk of TB-IRIS in HIV-positive patients taking anti-TB medication by 30%.

The trial for the study, which was conducted by the UCT Wellcome Centre for Infectious Diseases Research at Khayelitsha’s Site B HIV-TB clinic, involved 240 HIV-positive patients with very low CD4 counts, who had started TB treatment within the 30 days prior to enrolment.

Meintjes said it was critical to start patients with HIV, TB and very low CD4 counts on antiretrovirals within the first two weeks of treatment for TB, which consequently created a high risk of them developing the TB-IRIS.

Meintjies said TB-IRIS was characterised by severe inflammation which occurred shortly after patients on TB treatment started taking antiretroviral therapy. He said it was a serious risk that resulted in a quarter of affected patients being hospitalised.

“This is the first trial to show that TB-IRIS can be prevented in these patients, and represents an important contribution to the body of knowledge on management of HIV-TB co-infection,” said Meintjes.