The effect of HIV-associated tuberculosis, tuberculosis-IRIS and prednisone on lung functionMore about Open Access at the Crick
Authors listCari Stek Brian Allwood Elsa Du Bruyn Jozefien Buyze Charlotte Schutz Friedrich Thienemann Adele Lombard Robert Wilkinson Graeme Meintjes Lutgarde Lynen
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-1 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.
Journal European Respiratory Journal
Issue number 3