Header

UZH-Logo

Maintenance Infos

The effect of HIV-associated tuberculosis, tuberculosis-IRIS, and prednisone on lung function


Stek, Cari; Allwood, Brian; Du Bruyn, Elsa; Buyze, Jozefien; Schutz, Charlotte; Thienemann, Friedrich; Lombard, Adele; Wilkinson, Robert J; Meintjes, Graeme; Lynen, Lutgarde (2020). The effect of HIV-associated tuberculosis, tuberculosis-IRIS, and prednisone on lung function. European Respiratory Journal, 55(3):1901692.

Abstract

Residual pulmonary impairment is common after treatment for tuberculosis. Lung function data in patients with HIV-associated tuberculosis are scarce, especially in the context of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) and prophylactic prednisone. We aimed to determine the prevalence of lung function abnormalities in patients with HIV-associated tuberculosis and CD4 counts≤100 cells·μL<jats:sup>−1</jats:sup> and assess the effect of prophylactic prednisone and the development of paradoxical TB-IRIS on pulmonary impairment.We performed spirometry, six-minute walk test, and chest radiography at baseline (week 0), week 4, 12, and 28 in participants of the PredART trial, which evaluated a 28-day course of prednisone to prevent TB-IRIS in patients with HIV-associated tuberculosis commencing antiretroviral therapy.153 participants underwent spirometry and/or six-minute walk test at one or more time points. Abnormal spirometry measurements were present in 66% of participants at week 0 and 50% at week 28; low forced vital capacity was the commonest abnormality. Chest radiographs showed little or no abnormalities in the majority of participants.Prednisone use resulted in a 42 meters greater six-minute walk distance and a 4.9% higher percentage of predicted forced expiratory volume in 1 s at week 4; these differences were no longer significantly different from week 12 onwards. TB-IRIS did not significantly impair lung function outcome.Residual pulmonary impairment is common in HIV-associated tuberculosis. In patients with low CD4 counts, neither prophylactic prednisone as used in our study nor the development of TB-IRIS significantly affected week 28 pulmonary outcome.

Abstract

Residual pulmonary impairment is common after treatment for tuberculosis. Lung function data in patients with HIV-associated tuberculosis are scarce, especially in the context of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) and prophylactic prednisone. We aimed to determine the prevalence of lung function abnormalities in patients with HIV-associated tuberculosis and CD4 counts≤100 cells·μL<jats:sup>−1</jats:sup> and assess the effect of prophylactic prednisone and the development of paradoxical TB-IRIS on pulmonary impairment.We performed spirometry, six-minute walk test, and chest radiography at baseline (week 0), week 4, 12, and 28 in participants of the PredART trial, which evaluated a 28-day course of prednisone to prevent TB-IRIS in patients with HIV-associated tuberculosis commencing antiretroviral therapy.153 participants underwent spirometry and/or six-minute walk test at one or more time points. Abnormal spirometry measurements were present in 66% of participants at week 0 and 50% at week 28; low forced vital capacity was the commonest abnormality. Chest radiographs showed little or no abnormalities in the majority of participants.Prednisone use resulted in a 42 meters greater six-minute walk distance and a 4.9% higher percentage of predicted forced expiratory volume in 1 s at week 4; these differences were no longer significantly different from week 12 onwards. TB-IRIS did not significantly impair lung function outcome.Residual pulmonary impairment is common in HIV-associated tuberculosis. In patients with low CD4 counts, neither prophylactic prednisone as used in our study nor the development of TB-IRIS significantly affected week 28 pulmonary outcome.

Statistics

Citations

Dimensions.ai Metrics
3 citations in Web of Science®
3 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

4 downloads since deposited on 16 Jan 2020
2 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Pulmonary and Respiratory Medicine
Uncontrolled Keywords:Pulmonary and Respiratory Medicine
Language:English
Date:1 March 2020
Deposited On:16 Jan 2020 15:05
Last Modified:01 Jan 2021 19:18
Publisher:European Respiratory Society
ISSN:0903-1936
OA Status:Hybrid
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1183/13993003.01692-2019
PubMed ID:31862762

Download

Hybrid Open Access

Download PDF  'The effect of HIV-associated tuberculosis, tuberculosis-IRIS, and prednisone on lung function'.
Preview
Content: Accepted Version
Filetype: PDF
Size: 2MB
View at publisher