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

DOI: https://doi.org/10.29296/25877305-2023-02-04
Issue: 
2
Year: 
2023

P. Makarov(1); Associate Professor I. Kravchenko(2), MD
1-Tver State Medical University, Ministry of Health of Russia
2-Kazan State Medical University, Ministry of Health of the Russian Federation, Kazan

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
Keywords: 
infectious diseases
HIV infection
immune reconstitution inflammatory syndrome
tuberculosis
antiretroviral therapy
antituberculosis therapy
triglycerides
lipids

References: 
  1. Kirzhanova V.V., Grigorova N.I., Bobkov E.N. et al. Deyatel'nost' narkologicheskoi sluzhby v Rossiiskoi Federatsii v 2019-2020 godakh: Analiticheskii obzor. M.: FGBU «NMITs PN im. V.P. Serbskogo» Minzdrava Rossii, 2021 (in Russ.). URL: http://nncn.serbsky.ru/wp-content/uploads/2021/12/НаркологическаяСлужбаРФ-АО2019-2020.pdf
  2. Gosudarstvennyi doklad. O sostoyanii sanitarno-epidemiologicheskogo blagopoluchiya naseleniya v Rossiiskoi Federatsii v 2020 godu. (in Russ.). URL: https://www.rospotrebnadzor.ru/upload/iblock/5fa/gd-seb_02.06-_s-podpisyu_.pdf
  3. Markelov Yu.M., Pahomova E.V., Rozhkova I.I. Distribution and mortality patterns in patients co-infected with HIV and TB in Karelia. HIV Infection and Immunosuppressive Disorders. 2016; 8 (3): 65–73 (in Russ.). DOI: 10.22328/2077-9828-2016-8-3-65-73
  4. Pokrovskii V.V. VICh-infektsiya i SPID: natsional'noe rukovodstvo. M.: GEOTAR-Media, 2013; 608 (in Russ.).
  5. Bitnyova A.M., Kozlova T.P., Savintseva E.V. Features of the onset and course of the immune reconstitution inflammatory syndrome in patients with pulmonary tuberculosis. Problem Sciences. 2017; 6 (19): 104–5 (in Russ.).
  6. Azovtseva O.V., Arhipov G.S., Arkhipova E.I., et al. A comparative analysis of causes of death in HIV infected patients. HIV Infection and Immunosuppressive Disorders. 2015; 7 (4): 86–91 (in Russ.). DOI: 10.22328/2077-9828-2015-7-4-86-91
  7. Zakharova N.G., Dvorak S.I., Plavinski S.L. et al. The causes of unfavorable outcomes among patients taking HAART. Part 1. HIV Infection and Immunosuppressive Disorders. 2015; 7 (3): 48–55 (in Russ.). DOI: 10.22328/2077-9828-2015-7-3-48-55
  8. Kozlov V.A., Tikhonova E.P., Savchenko A.A. et al. Clinical immunology. A practical guide for infectious disease specialists. Krasnoyarsk: Polikor, 2021; 563 p. (in Russ.). DOI:10.17513/np.518
  9. VICh-infektsiya u vzroslykh. Klinicheskie rekomendatsii. Minzdrav Rossii, 2020 (in Russ.). URL: https://cr.minzdrav.gov.ru/schema/79_1
  10. Pokrovskii V.V., Yurin O.G., Kravchenko A.V. et al. Natsional'nye rekomendatsii po dispansernomu nablyudeniyu i lecheniyu bol'nykh VICh-infektsiei 2017. Klinicheskii protokol. Epidemiology and Infectious Diseases. Current Items. 2017; S6: 1–80 (in Russ.).
  11. Grebneva N.Yu., Sanaeva E.P., Saushkina A.S. et al. Spectroscopic methods in the analysis of n-substituted phenothiazines. Russian Military Medical Academy Reports. 2020; 39 (S3-4): 34–8 (in Russ.).
  12. Oleynik A.F., Fazylov V.H., Beshimov A.T. Clinical, immunological and virological indicators of antiretroviral therapy efficiency. Bulletin of Russian State Medical University. 2017; 1: 59–65 (in Russ.). DOI: 10.24075/brsmu.2017-01-07
  13. Boeva E.V., Belyakov N.A. Immune reconstitution Inflammatory syndrome. Russian Journal of Infection and Immunity. 2018; 8 (2): 139–49 (in Russ.). DOI: 10.15789/2220-7619-2018-2-139-149
  14. Sahin F., Yildiz P. Distinctive biochemical changes in pulmonary tuberculosis and pneumonia. Arch Med Sci. 2013; 9 (4): 656–61. DOI: 10.5114/aoms.2013.34403
  15. Wipperman M.F., Sampson N.S., Thomas S.T. Pathogen Roid Rage: Cholesterol utilization by Mycobacterium tuberculosis. Crit Rev Biochem Mol Biol. 2014; 49 (4): 269–93. DOI: 10.3109/10409238.2014.895700
  16. Kaminskaya G.O., Аbdullaev R.Yu. Tuberculosis and lipid exchange. Tuberculosis and Lung Diseases. 2016; 94 (6): 53–63 (in Russ.). DOI: 10.21292/2075-1230-2016-94-6-53-63
  17. Makarov V.K., Makarov P.V. Patent №2745026, Rossiiskaya Federatsiya, G01N 33/48. Sposob opredeleniya vospalitel'nogo sindroma vosstanovleniya immuniteta u bol'nykh s tuberkulezom i VICh-infektsiei na fone primeneniya vysokoaktivnoi antiretrovirusnoi terapii. №2020124959; zayavl. 28.07.2020; opubl. 18.03.2021; Byul. №8 (in Russ.).
  18. Stek C., Schutz C., Blumenthal L. еt al. Preventing Paradoxical Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in High-Risk Patients: Protocol of a Randomized Placebo-Controlled Trial of Prednisone (PredART Trial). JMIR Res Protoc. 2016; 5 (3): e173. DOI: 10.2196/resprot.6046