PT - JOURNAL ARTICLE AU - R A M Breen AU - C J Smith AU - H Bettinson AU - S Dart AU - B Bannister AU - M A Johnson AU - M C I Lipman TI - Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection AID - 10.1136/thx.2003.019224 DP - 2004 Aug 01 TA - Thorax PG - 704--707 VI - 59 IP - 8 4099 - http://thorax.bmj.com/content/59/8/704.short 4100 - http://thorax.bmj.com/content/59/8/704.full SO - Thorax2004 Aug 01; 59 AB - Background: It has been suggested that deterioration of tuberculosis (TB) during appropriate treatment, termed a paradoxical reaction (PR), is more common and severe in HIV positive individuals on highly active antiretroviral therapy (HAART). Method: A study was undertaken to determine the frequency of PR and its associated features in a population of HIV+TB+ patients and a similar sized group of HIV−TB+ individuals. Results: PR occurred in 28% of 50 HIV+TB+ patients and 10% of 50 HIV−TB+ patients. Disseminated TB was present in eight of 13 HIV+TB+ patients and four of five HIV−TB+ patients with PR. In 28 HIV+TB+ patients starting HAART, PR was significantly associated with commencing HAART within 6 weeks of starting antituberculosis treatment (p = 0.03) and was more common in those with disseminated TB (p = 0.09). No association was found between development of PR and baseline CD4 count or CD4 response to HAART. Conclusions: PR is common in HIV infected and uninfected individuals with TB. Early introduction of HAART and the presence of disseminated TB appear to be important in co-infected patients.