African Health Sciences
Makerere University Medical School
Vol. 8, No. 3, 2008, pp. 190-195
Bioline Code: hs08040
Full paper language: English
Document type: Short Communication
Document available free of charge
African Health Sciences, Vol. 8, No. 3, 2008, pp. 190-195
© Copyright 2008 - Makerere Medical School, Uganda
Worsening and unmasking of tuberculosis in HIV-1 infected patients after initiating highly active anti-retroviral therapy in Uganda|
Baalwa, Joshua; Mayanja-Kizza, Harriet; Kamya, Moses R.; John, Laurence; Kambugu, Andrew & Colebunders, Robert
To determine the proportion of patients developing active tuberculosis (TB) versus that of patients who experience worsening of TB, after initiating highly active anti retroviral therapy (HAART).
Charts of HAART naïve patients with or without clinically active TB who consecutively commenced HAART at Mulago Hospital Infectious Diseases Institute were reviewed. Patients were assessed for worsening of TB on treatment or development of new active TB (unmasking of TB) after initiating HAART.
Of 271 patients without active TB at baseline who initiated HAART, 16 (5.9%) developed active TB within 6 months (early unmasking) and 10 (2.7%) after 6 months (late unmasking). Seven of 10 late unmasking patients had a past history of treatment for a TB disease episode. Of 45 patients who commenced HAART with coexisting active TB, 13 (29%) experienced worsening of TB symptoms, signs and/or radiological features. Nine of these 45 commenced HAART during the intensive phase of TB treatment, of whom 2 (22%) experienced worsening of TB. Thirty six of 45 started HAART during the continuation phase of TB treatment of whom 11 (31%), experienced worsening of TB. The median time from initiation of HAART to worsening of TB in patients on concurrent active TB treatment was 5 weeks, and 18 weeks to unmasking of new active tuberculosis.
Unmasking of TB was commonest in the first 6 months of HAART and declined in the subsequent months with most in the late unmasking group being TB recurrences. Worsening of TB occurred even after HAART was delayed to the continuation phase of TB treatment.
Immune reconstitution, tuberculosis, antiretroviral therapy