Risk factors for lethal outcome in tuberculosis-associated immune reconstitution inflammatory syndrome with tuberculous lesions of the central nervous system

Abstract

Objective — to study the relation of death in tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) and central nervous system (CNS) tuberculosis with the following factors: 1) baseline CD4+ T-lymphocyte count, cells/μL, at the beginning of treatment; 2) the level of viral load at the beginning of treatment; 3) resistance to antimycobacterial drugs (R, HR, HR + others) or its absence at the beginning of treatment; 4) age of patients; 5) gender of patients. Materials and methods. 55 cases of neurological TB-IRIS were analyzed. These patients were treated and observed during the 1 year in anti-tuberculosis facilities in Kyiv and Kyiv region in 2017—2019. All patients received ART in accordance with the HIV treatment protocols adopted in Ukraine. Treatment of tuberculosis was carried out taking into account the susceptibility of the pathogen to antimycobacterial therapy according to the standard of tuberculosis treatment adopted in Ukraine. The logistic regression model construction method was used to analyze. A multifactor model for predicting the risk of death in neurological TB-IRIS was built. Results and discussion. After calculations, two factor signs were identified, associated with the risk of death: the baseline level of CD4+ lymphocytes in 1 μl of blood at the beginning of treatment and the level of viral load (copies of HIV RNA in 1 μl) at the beginning of treatment. Conclusions. It was found that the risk of death in TB-IRIS with tuberculous lesions of the CNS is significantly associated (p < 0.05) with the following factors: 1) the level of CD4+ lymphocytes in 1 μl at the beginning of treatment; 2) the level of viral load at the beginning of treatment (copies of HIV RNA in 1 μl).