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

¹ Department of Thoracic and HIV Medicine, Royal Free Hospital, London, UK
² Department of Infectious Diseases, Royal Free Hospital, London, UK
³ Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK

Correspondence to:
Correspondence to:
Dr R Breen
Department of Thoracic and HIV Medicine, Royal Free Hospital, London NW3 2QG, UK; rambreen{at}doctors.org.uk

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.

Keywords: tuberculosis; paradoxical reaction; HIV/AIDS; antiretroviral treatment

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