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Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS


Stek, Cari; Buyze, Jozefien; Menten, Joris; Schutz, Charlotte; Thienemann, Friedrich; Blumenthal, Lisette; Maartens, Gary; Boyles, Tom; Wilkinson, Robert J; Meintjes, Graeme; Lynen, Lutgarde (2020). Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS. Journal of Acquired Immune Deficiency Syndromes, Publish :Epub ahead of print.

Abstract

Background:

The diagnosis of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) relies on characteristic clinical features synthesized as the International Network for the Study of HIV-associated IRIS (INSHI) case definition. There is no confirmatory laboratory test.
Setting:

Site B HIV-TB clinic in Khayelitsha, Cape Town, South Africa.
Methods:

Using data of participants with HIV-associated tuberculosis starting antiretroviral treatment from a prospective trial evaluating prednisone for TB-IRIS prevention, we applied latent class analysis to model a gold standard for TB-IRIS.

The model-predicted probability of TB-IRIS for each participant was used to assess the performance of the INSHI case definition and compare its diagnostic accuracy with several adapted case definitions.
Results:

Data for this analysis were complete for 217 participants; 41% developed TB-IRIS. Our latent class model included the following parameters: respiratory symptoms, night sweats, INSHI major criteria 1, 2, and 4, maximum CRP >90 mg/l, maximum heart rate >120/min, maximum temperature >37.7 0C, and pre-ART CD4 count <50 cells/μl. The model estimated a TB-IRIS incidence of 43% and had optimal goodness of fit (Χ2=337, p=1.0). The INSHI case definition displayed a sensitivity of 0.77 and a specificity of 0.86. Replacing all the minor INSHI criteria with objectives measures (CRP elevation, fever, and/or tachycardia) resulted in a definition with better diagnostic accuracy, with a sensitivity of 0.89 and a specificity of 0.88.
Conclusion:

The INSHI case definition identifies TB-IRIS with reasonable accuracy. Amending the case definition by replacing INSHI minor criteria with objective variables improved sensitivity without loss of specificity.

Abstract

Background:

The diagnosis of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) relies on characteristic clinical features synthesized as the International Network for the Study of HIV-associated IRIS (INSHI) case definition. There is no confirmatory laboratory test.
Setting:

Site B HIV-TB clinic in Khayelitsha, Cape Town, South Africa.
Methods:

Using data of participants with HIV-associated tuberculosis starting antiretroviral treatment from a prospective trial evaluating prednisone for TB-IRIS prevention, we applied latent class analysis to model a gold standard for TB-IRIS.

The model-predicted probability of TB-IRIS for each participant was used to assess the performance of the INSHI case definition and compare its diagnostic accuracy with several adapted case definitions.
Results:

Data for this analysis were complete for 217 participants; 41% developed TB-IRIS. Our latent class model included the following parameters: respiratory symptoms, night sweats, INSHI major criteria 1, 2, and 4, maximum CRP >90 mg/l, maximum heart rate >120/min, maximum temperature >37.7 0C, and pre-ART CD4 count <50 cells/μl. The model estimated a TB-IRIS incidence of 43% and had optimal goodness of fit (Χ2=337, p=1.0). The INSHI case definition displayed a sensitivity of 0.77 and a specificity of 0.86. Replacing all the minor INSHI criteria with objectives measures (CRP elevation, fever, and/or tachycardia) resulted in a definition with better diagnostic accuracy, with a sensitivity of 0.89 and a specificity of 0.88.
Conclusion:

The INSHI case definition identifies TB-IRIS with reasonable accuracy. Amending the case definition by replacing INSHI minor criteria with objective variables improved sensitivity without loss of specificity.

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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
Uncontrolled Keywords:Pharmacology (medical), Infectious Diseases
Language:English
Date:17 December 2020
Deposited On:29 Jan 2021 09:27
Last Modified:20 Feb 2021 02:13
Publisher:Lippincott Williams & Wilkins
ISSN:1525-4135
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1097/qai.0000000000002606
PubMed ID:33394813

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