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Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection

Breen, RAM; Smith, CJ; Bettinson, H; Dart, S; Bannister, B; Johnson, MA; Lipman, MCI; (2004) Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection. THORAX , 59 (8) 704 - 707. 10.1136/thx.2003.019224.

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Abstract

Background: It has been suggested that deterioration of tuberculosis ( TB) during appropriate treatment, termed a paradoxical reaction ( PR), is more common and severe in HIV positive individuals on highly active antiretroviral therapy ( HAART).Method: A study was undertaken to determine the frequency of PR and its associated features in a population of HIV+TB+ patients and a similar sized group of HIV-TB+ individuals.Results: PR occurred in 28% of 50 HIV+TB+ patients and 10% of 50 HIV-TB+ patients. Disseminated TB was present in eight of 13 HIV+TB+ patients and four of five HIV-TB+ patients with PR. In 28 HIV+TB+ patients starting HAART, PR was significantly associated with commencing HAART within 6 weeks of starting antituberculosis treatment ( p = 0.03) and was more common in those with disseminated TB ( p = 0.09). No association was found between development of PR and baseline CD4 count or CD4 response to HAART.Conclusions: PR is common in HIV infected and uninfected individuals with TB. Early introduction of HAART and the presence of disseminated TB appear to be important in co-infected patients.

Type: Article
Title: Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection
DOI: 10.1136/thx.2003.019224
Keywords: ACTIVE ANTIRETROVIRAL THERAPY, INFECTED PERSONS, PULMONARY, DISEASE, AIDS
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/146544
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