Treatment with tumor necrosis factor‐α inhibitors, history of allergy, and hypercalcemia are risk factors of immune reconstitution inflammatory syndrome in hiv‐negative pulmonary tuberculosis patients

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is an immune reaction that occurs along with the recovery of the patientʹs immunity. Tuberculosis‐related IRIS (TB‐IRIS) upon tumor necrosis factor (TNF)‐α inhibitor treatment has been reported in non‐human immunodeficiency virus (HIV) patients. However, the importance of biological treatment, as a risk factor of IRIS, has not yet been established. In this study, we examined TB‐IRIS in non‐HIV patients to explore the role of TNF‐α inhibitor treatment. Out of 188 patients with pulmonary TB, seven patients had IRIS. We examined univariate logistic and multivariate analysis to elucidate risk factors of TB‐IRIS. Univariate analysis indicated that usage of immunosuppressive drugs, TNF‐α inhibitors, and history of food or drug allergy were significantly related with TB‐IRIS. On initial treatment, the values of serological markers such as serum albumin and serum calcium were significantly related with TB‐IRIS. There was a higher mortality rate in patients with TB‐IRIS. Furthermore, multivariate analysis revealed that usage of TNF‐α inhibitors, history of allergy, and serum hypercalcemia were related to TB‐IRIS. Usage of TNF‐α inhibitors, history of allergy, and serum hypercalcemia may be independent predictors of TB‐IRIS in non‐HIV patients. Since higher mortality has been reported for TB‐ IRIS, we should pay attention to TB patients with these risk factors.