NEW YORK (Reuters Health) – Once a diagnosis of tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is confirmed in HIV patients being treated with antiretroviral therapy, a course of prednisone reduces the need for hospitalization, a South African team has shown.

The availability of antiretroviral therapy for HIV in developing countries means that many patients with concomitant tuberculosis are being treated, Dr. Graeme Meintjes at the University of Cape Town and colleagues point out in the September 20 issue of AIDS. Paradoxical TB-IRIS is believed to be a result of the restoration of immune responses to the antigen, producing inflammation at disease sites.

“TB-IRIS occurs in 8-43% patients starting ART while on antitubercular therapy,” the authors note, and it often requires hospitalization.

The researchers investigated whether glucocorticoid therapy would reduce morbidity associated with TB-IRIS in a randomized controlled trial. Out of 287 patients screened, 110 were enrolled and assigned to a 4-week course of prednisone or placebo.

“The median cumulative number of hospital days (with outpatient therapeutic procedures counted as one additional day) was 0 in the prednisone arm and 3 in the placebo arm (p=0.04),” Dr. Meintjes and colleagues report.

Infections occurred in 27 patients on prednisone and in 17 given placebo (p=0.05) during the 12-week study period, but the number of serious infections were similar (2 vs 4, respectively; p=0.40).

The researchers conclude that the availability of effective therapy for TB-IRIS may “may make clinicians less reluctant to start ART early in patients with tuberculosis and advanced immunosuppression.” However, they stress that it is crucial to be certain of the diagnosis before starting prednisone as unnecessary glucocorticoids may be harmful.

AIDS 2010;24:2381-2390.