@article{Stek9000,
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 {\textgreater}90 mg/l, maximum heart rate {\textgreater}120/min, maximum temperature {\textgreater}37.7 0C, and pre-ART CD4 count {\textless}50 cells/$\mu$l. 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. Corresponding author: Cari Stek, Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Rd, Observatory 7925, South Africa +27 21 4066389, cari{\_}stek@hotmail.com The authors report no conflicts of interest related to this work. 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. Copyright {\textcopyright} 2021 Wolters Kluwer Health, Inc. All rights reserved.},
author = {Stek, Cari and Buyze, Jozefien and Menten, Joris and Schutz, Charlotte and Thienemann, Friedrich and Blumenthal, Lisette and Maartens, Gary and Boyles, Tom and Wilkinson, Robert J and Meintjes, Graeme A and Lynen, Lutgarde},
doi = {10.1097/QAI.0000000000002606},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Stek et al. - 2021 - Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS.pdf:pdf},
issn = {1525-4135},
journal = {Journal of Acquired Immune Deficiency Syndromes},
keywords = {HIV,OA,TB-IRIS,Tuberculosis,fund{\_}ack,immune reconstitution inflammatory syndrome,latent class analysis,original},
mendeley-tags = {OA,fund{\_}ack,original},
number = {5},
pages = {587--592},
pmid = {33394813},
title = {{Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS}},
url = {https://journals.lww.com/jaids/Fulltext/9000/Diagnostic{\_}accuracy{\_}of{\_}the{\_}INSHI{\_}consensus{\_}case.95983.aspx},
volume = {86},
year = {2021}
}

{"_id":"REA25kCk5PCtEwgZG","bibbaseid":"stek-buyze-menten-schutz-thienemann-blumenthal-maartens-boyles-etal-diagnosticaccuracyoftheinshiconsensuscasedefinitionforthediagnosisofparadoxicaltuberculosisiris-2021","author_short":["Stek, C.","Buyze, J.","Menten, J.","Schutz, C.","Thienemann, F.","Blumenthal, L.","Maartens, G.","Boyles, T.","Wilkinson, R. J","Meintjes, G. A","Lynen, L."],"bibdata":{"bibtype":"article","type":"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 \\textgreater90 mg/l, maximum heart rate \\textgreater120/min, maximum temperature \\textgreater37.7 0C, and pre-ART CD4 count \\textless50 cells/$μ$l. 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. Corresponding author: Cari Stek, Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Rd, Observatory 7925, South Africa +27 21 4066389, cari_stek@hotmail.com The authors report no conflicts of interest related to this work. 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. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.","author":[{"propositions":[],"lastnames":["Stek"],"firstnames":["Cari"],"suffixes":[]},{"propositions":[],"lastnames":["Buyze"],"firstnames":["Jozefien"],"suffixes":[]},{"propositions":[],"lastnames":["Menten"],"firstnames":["Joris"],"suffixes":[]},{"propositions":[],"lastnames":["Schutz"],"firstnames":["Charlotte"],"suffixes":[]},{"propositions":[],"lastnames":["Thienemann"],"firstnames":["Friedrich"],"suffixes":[]},{"propositions":[],"lastnames":["Blumenthal"],"firstnames":["Lisette"],"suffixes":[]},{"propositions":[],"lastnames":["Maartens"],"firstnames":["Gary"],"suffixes":[]},{"propositions":[],"lastnames":["Boyles"],"firstnames":["Tom"],"suffixes":[]},{"propositions":[],"lastnames":["Wilkinson"],"firstnames":["Robert","J"],"suffixes":[]},{"propositions":[],"lastnames":["Meintjes"],"firstnames":["Graeme","A"],"suffixes":[]},{"propositions":[],"lastnames":["Lynen"],"firstnames":["Lutgarde"],"suffixes":[]}],"doi":"10.1097/QAI.0000000000002606","file":":C$\\$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Stek et al. - 2021 - Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS.pdf:pdf","issn":"1525-4135","journal":"Journal of Acquired Immune Deficiency Syndromes","keywords":"HIV,OA,TB-IRIS,Tuberculosis,fund_ack,immune reconstitution inflammatory syndrome,latent class analysis,original","mendeley-tags":"OA,fund_ack,original","number":"5","pages":"587–592","pmid":"33394813","title":"Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS","url":"https://journals.lww.com/jaids/Fulltext/9000/Diagnostic\\_accuracy\\_of\\_the\\_INSHI\\_consensus\\_case.95983.aspx","volume":"86","year":"2021","bibtex":"@article{Stek9000,\r\nabstract = {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 {\\textgreater}90 mg/l, maximum heart rate {\\textgreater}120/min, maximum temperature {\\textgreater}37.7 0C, and pre-ART CD4 count {\\textless}50 cells/$\\mu$l. 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. Corresponding author: Cari Stek, Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Rd, Observatory 7925, South Africa +27 21 4066389, cari{\\_}stek@hotmail.com The authors report no conflicts of interest related to this work. 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. Copyright {\\textcopyright} 2021 Wolters Kluwer Health, Inc. All rights reserved.},\r\nauthor = {Stek, Cari and Buyze, Jozefien and Menten, Joris and Schutz, Charlotte and Thienemann, Friedrich and Blumenthal, Lisette and Maartens, Gary and Boyles, Tom and Wilkinson, Robert J and Meintjes, Graeme A and Lynen, Lutgarde},\r\ndoi = {10.1097/QAI.0000000000002606},\r\nfile = {:C$\\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Stek et al. - 2021 - Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS.pdf:pdf},\r\nissn = {1525-4135},\r\njournal = {Journal of Acquired Immune Deficiency Syndromes},\r\nkeywords = {HIV,OA,TB-IRIS,Tuberculosis,fund{\\_}ack,immune reconstitution inflammatory syndrome,latent class analysis,original},\r\nmendeley-tags = {OA,fund{\\_}ack,original},\r\nnumber = {5},\r\npages = {587--592},\r\npmid = {33394813},\r\ntitle = {{Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS}},\r\nurl = {https://journals.lww.com/jaids/Fulltext/9000/Diagnostic{\\_}accuracy{\\_}of{\\_}the{\\_}INSHI{\\_}consensus{\\_}case.95983.aspx},\r\nvolume = {86},\r\nyear = {2021}\r\n}\r\n","author_short":["Stek, C.","Buyze, J.","Menten, J.","Schutz, C.","Thienemann, F.","Blumenthal, L.","Maartens, G.","Boyles, T.","Wilkinson, R. J","Meintjes, G. A","Lynen, L."],"key":"Stek9000","id":"Stek9000","bibbaseid":"stek-buyze-menten-schutz-thienemann-blumenthal-maartens-boyles-etal-diagnosticaccuracyoftheinshiconsensuscasedefinitionforthediagnosisofparadoxicaltuberculosisiris-2021","role":"author","urls":{"Paper":"https://journals.lww.com/jaids/Fulltext/9000/Diagnostic\\_accuracy\\_of\\_the\\_INSHI\\_consensus\\_case.95983.aspx"},"keyword":["HIV","OA","TB-IRIS","Tuberculosis","fund_ack","immune reconstitution inflammatory syndrome","latent class analysis","original"],"metadata":{"authorlinks":{}}},"bibtype":"article","biburl":"https://drive.google.com/uc?export=download&id=1-JLqZ7RwZ3VC2d6ErLGHAtOeMRS_7GCz","dataSources":["9bX4N36CTXtCXNFMd","wrEvssexmuYudwQw9","6GMFi5DCojy3jHY44","Krmt6gt9ktB2s6ARh"],"keywords":["hiv","oa","tb-iris","tuberculosis","fund_ack","immune reconstitution inflammatory syndrome","latent class analysis","original"],"search_terms":["diagnostic","accuracy","inshi","consensus","case","definition","diagnosis","paradoxical","tuberculosis","iris","stek","buyze","menten","schutz","thienemann","blumenthal","maartens","boyles","wilkinson","meintjes","lynen"],"title":"Diagnostic accuracy of the INSHI consensus case definition for the diagnosis of paradoxical tuberculosis-IRIS","year":2021}