BibTex format
@article{Stek:2021:10.1097/QAI.0000000000002606,
author = {Stek, C and Buyze, J and Menten, J and Schutz, C and Tinman, F and Blumenthal, L and Maartens, G and Boyles, T and Wilkinson, RJ and Meintjes, G and Lynen, L},
doi = {10.1097/QAI.0000000000002606},
journal = {JAIDS: Journal of Acquired Immune Deficiency Syndromes},
pages = {587--592},
title = {Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS},
url = {http://dx.doi.org/10.1097/QAI.0000000000002606},
volume = {86},
year = {2021}
}
RIS format (EndNote, RefMan)
TY - JOUR
AB - BackgroundThe diagnosis of paradoxical tuberculosis-associated immune reconstitution inflammatorysyndrome (TB-IRIS) relies on characteristic clinical features synthesized as the InternationalNetwork for the Study of HIV-associated IRIS (INSHI) case definition. There is noconfirmatory laboratory test.SettingSite B HIV-TB clinic in Khayelitsha, Cape Town, South Africa.MethodsUsing data of participants with HIV-associated tuberculosis starting antiretroviral treatmentfrom a prospective trial evaluating prednisone for TB-IRIS prevention, we applied latentclass analysis to model a gold standard for TB-IRIS.The model-predicted probability of TB-IRIS for each participant was used to assess theperformance of the INSHI case definition and compare its diagnostic accuracy with severaladapted case definitions.ResultsData for this analysis were complete for 217 participants; 41% developed TB-IRIS. Our latentclass model included the following parameters: respiratory symptoms, night sweats, INSHImajor 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 estimateda TB-IRIS incidence of 43% and had optimal goodness of fit (Χ2=337, p=1.0). The INSHI casedefinition displayed a sensitivity of 0.77 and a specificity of 0.86. Replacing all the minorINSHI criteria with objectives measures (CRP elevation, fever, and/or tachycardia) resultedin a definition with better diagnostic accuracy, with a sensitivity of 0.89 and a specificity of0.88.ConclusionThe INSHI case definition identifies TB-IRIS with reasonable accuracy. Amending the casedefinition by replacing INSHI minor criteria with objective variables improved sensitivitywithout loss of specificity.
AU - Stek,C
AU - Buyze,J
AU - Menten,J
AU - Schutz,C
AU - Tinman,F
AU - Blumenthal,L
AU - Maartens,G
AU - Boyles,T
AU - Wilkinson,RJ
AU - Meintjes,G
AU - Lynen,L
DO - 10.1097/QAI.0000000000002606
EP - 592
PY - 2021///
SN - 1525-4135
SP - 587
TI - Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS
T2 - JAIDS: Journal of Acquired Immune Deficiency Syndromes
UR - http://dx.doi.org/10.1097/QAI.0000000000002606
UR - https://journals.lww.com/jaids/Fulltext/2021/04150/Diagnostic_Accuracy_of_the_INSHI_Consensus_Case.13.aspx
VL - 86
ER -