The effect of HIV-associated tuberculosis, tuberculosis-IRIS, and prednisone on lung function
CariÂ Stek,Â BrianÂ Allwood,Â ElsaÂ Du Bruyn,Â JozefienÂ Buyze,Â CharlotteÂ Schutz,Â FriedrichÂ Thienemann,Â AdeleÂ Lombard,Â Robert J.Â Wilkinson,Â GraemeÂ Meintjes,Â LutgardeÂ Lynen
European Respiratory JournalÂ 2019;Â DOI:Â 10.1183/13993003.01692-2019
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 countsâ‰¤100â€…cellsÂ·Î¼Lâˆ’1Â 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 1â€…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.
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Conflict of interest: Dr. Stek has nothing to disclose.
Conflict of interest: Dr. Allwood has nothing to disclose.
Conflict of interest: Dr. Du Bruyn has nothing to disclose.
Conflict of interest: Dr. Buyze has nothing to disclose.
Conflict of interest: Dr. Schutz has nothing to disclose.
Conflict of interest: Dr. Thienemann has nothing to disclose.
Conflict of interest: Dr. Lombard has nothing to disclose.
Conflict of interest: Dr. Wilkinson reports grants from Wellcome, grants from UK research and Innovation, grants from National Institutes of Health, grants from Foundation for the National Institues of Health, grants from European and Developing Countries Clinical Trials Partnership, during the conduct of the study.
Conflict of interest: Dr. Meintjes has nothing to disclose.
Conflict of interest: Dr. Lynen has nothing to disclose.
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- ReceivedÂ August 26, 2019.
- AcceptedÂ November 29, 2019.
- Copyright Â©ERS 2019