Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS
File(s)
Published version
Author(s)
Type
Journal Article
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.
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.
Date Issued
2021-04-15
Date Acceptance
2020-12-07
Citation
JAIDS: Journal of Acquired Immune Deficiency Syndromes, 2021, 86 (5), pp.587-592
ISSN
1525-4135
Publisher
Lippincott, Williams & Wilkins
Start Page
587
End Page
592
Journal / Book Title
JAIDS: Journal of Acquired Immune Deficiency Syndromes
Volume
86
Issue
5
Copyright Statement
© 2020 The Author(s). Published by Wolters Kluwer Health, Inc.
This is an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use, distribution,
and reproduction in any medium, provided the original work is properly cited.
This is an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use, distribution,
and reproduction in any medium, provided the original work is properly cited.
http://creativecommons.org/licenses/by/4.0/
Sponsor
Wellcome Trust
EDCTP
Wellcome Trust
Identifier
https://journals.lww.com/jaids/Fulltext/2021/04150/Diagnostic_Accuracy_of_the_INSHI_Consensus_Case.13.aspx
Grant Number
104803/Z/14/Z
RIA2017T-2004
WDAI_P83556
Subjects
Virology
1103 Clinical Sciences
1117 Public Health and Health Services
Publication Status
Published
Date Publish Online
2021-04-15