Residual pulmonary impairment is common after treatment for tuberculosis (TB). Lung function data in patients with HIV-associated TB are scarce, especially in the context of paradoxical TB-associated immune reconstitution inflammatory syndrome (TB-IRIS) and prophylactic prednisone. We aimed to determine the prevalence of lung function abnormalities in patients with HIV-associated TB and CD4 counts ≤100 cells·μL−1 and assess the effect of prophylactic prednisone and the development of paradoxical TB-IRIS on pulmonary impairment. We performed spirometry, 6-min walk test (6MWT) and chest radiography at baseline (week 0) and at weeks 4, 12 and 28 in participants of the PredART trial, which evaluated a 28-day course of prednisone to prevent TB-IRIS in patients with HIV-associated TB commencing antiretroviral therapy. 153 participants underwent spirometry and/or 6MWT at one or more time points. Abnormal spirometry measurements were present in 66% of participants at week 0 and 50% at week 28; low forced vital capacity was the commonest abnormality. Chest radiographs showed little or no abnormalities in the majority of participants. Prednisone use resulted in a 42 m greater 6-min walk distance and a 4.9% higher percentage of predicted forced expiratory volume in 1 s at week 4; these differences were no longer significantly different from week 12 onwards. TB-IRIS did not significantly impair lung function outcome. Residual pulmonary impairment is common in HIV-associated TB. In patients with low CD4 counts, neither prophylactic prednisone as used in our study nor the development of TB-IRIS significantly affected week-28 pulmonary outcome. Post-tuberculosis lung disease is common in patients with HIV-associated TB at high risk of TB-IRIS (CD4 count ≤100 cells·μL−1). Neither TB-IRIS itself, nor prednisone treatment, affected long-term pulmonary outcomes in a South African clinical setting. http://bit.ly/2RjMl9c

中文翻译：

---

HIV相关结核病、结核病-IRIS和泼尼松对肺功能的影响

肺结核 (TB) 治疗后残留的肺损伤很常见。HIV 相关 TB 患者的肺功能数据很少，特别是在矛盾的 TB 相关免疫重建炎症综合征 (TB-IRIS) 和预防性泼尼松的情况下。我们旨在确定 HIV 相关 TB 和 CD4 计数≤100 个细胞·μL-1 的患者肺功能异常的患病率，并评估预防性泼尼松的影响和矛盾的 TB-IRIS 对肺损伤的发展。我们在基线（第 0 周）和第 4、12 和 28 周对 PredART 试验的参与者进行了肺量测定、6 分钟步行试验 (6MWT) 和胸片检查，该试验评估了 28 天泼尼松疗程以预防 TB-IRIS在开始抗逆转录病毒治疗的 HIV 相关结核病患者中。153 名参与者在一个或多个时间点接受了肺活量测定和/或 6MWT。66% 的参与者在第 0 周和 50% 在第 28 周出现异常肺活量测量值；低用力肺活量是最常见的异常。大多数参与者的胸片显示很少或没有异常。使用泼尼松导致第 4 周 6 分钟步行距离增加 42 m，1 秒内预测用力呼气量的百分比增加 4.9%；从第 12 周开始，这些差异不再有显着差异。TB-IRIS 没有显着损害肺功能结果。残留肺损伤在 HIV 相关结核病中很常见。在 CD4 计数低的患者中，我们研究中使用的预防性泼尼松和 TB-IRIS 的发展均未显着影响第 28 周的肺部结局。结核病后肺病在具有 TB-IRIS 高风险（CD4 计数≤100 个细胞·μL-1）的 HIV 相关结核病患者中很常见。在南非的临床环境中，无论是 TB-IRIS 本身还是泼尼松治疗，都不会影响长期肺部结局。http://bit.ly/2RjMl9c