Tuberculosis-immune reconstitution inflammatory syndrome

Massimiliano Lanzafame; Sandro Vento

doi:10.1016/j.jctube.2016.03.002

Tuberculosis-immune reconstitution inflammatory syndrome

J Clin Tuberc Other Mycobact Dis. 2016 Mar 11:3:6-9. doi: 10.1016/j.jctube.2016.03.002. eCollection 2016 May.

Authors

Massimiliano Lanzafame¹, Sandro Vento²

Affiliations

¹ Infectious Diseases Unit, "G.B. Rossi" University Hospital, Verona, Italy.
² Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan.

Abstract

Tuberculosis-immune reconstitution inflammatory syndrome is an excessive immune response against Mycobacterium tuberculosis that may occur in either HIV-infected or uninfected patients, during or after completion of anti-TB therapy. In HIV-infected patients it occurs after initiation of antiretroviral therapy independently from an effective suppression of HIV viremia. There are two forms of IRIS: paradoxical or unmasking. Paradoxical IRIS is characterized by recurrent, new, or worsening symptoms of a treated case. Unmasking IRIS is an antiretroviral-associated inflammatory manifestation of a subclinical infection with a hastened presentation. The pathogenesis is incompletely understood and the epidemiology partially described. No specific tests can establish or rule out the diagnosis. Treatment is based on the use of anti-tuberculosis drugs sometime with adjunctive corticosteroids. Mortality is generally low.

Keywords: Antiretrovirals; HIV; IRIS; Immune reconstitution; Tuberculosis.

Publication types

Review