A Study of Tb-Associated Immune Reconstitution Inflammatory Syndrome Using the Consensus Case-Definition (Report)
Tuberculosis (TB) is the most common opportunistic infection among human immunodeficiency virus (HIV) infected patients in developing countries (1). Patients with HIV-associated TB have advanced HIV disease and are at increased risk of death and new opportunistic infections (2-8). Highly active antiretroviral therapy (HAART) markedly decreases HIV-related morbidity and mortality in these patients (8). While the immune restoration following HAART reduces the risk of disease progression, it may also result in exacerbation of certain clinical manifestations known as immune reconstitution inflammatory syndrome (IRIS) (9,10). IRIS results from rapid restoration of pathogen-specific immune responses. It manifests as either a deterioration of previously diagnosed infection (paradoxical reaction) or an appearance of previously undiagnosed sub-clinical infection (unmasking reaction). A considerable proportion of patients with HIV-associated TB but on HAART develop IRIS reactions (11-13). Nonetheless, the diagnosis of TB-IRIS in resource-limited settings remains difficult to establish. Recently, a consensus case-definition for TB-associated IRIS has been proposed. This includes paradoxical TB-associated IRIS and antiretroviral treatment (ART) associated TB with provisional case-definition of unmasking TB-associated IRIS14. However, the performance of these case-definitions has not been formally evaluated. In the present study, we describe the frequency and risk factors of TB-associated IRIS diagnosed using the consensus case-definition.