Diagnosis and Management of Tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS)

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Last updated June 10, 2014
Case Authors: 
Christopher Behrens, MD
Clinical Assistant Professor
Department of Global Health, Family Medicine, and Medicine
University of Washington School of Medicine 
G. Manoharan, MD
Clinical Associate Professor
Department of Global Health
University of Washington School of Medicine
Medical Director, International Training and Education Center for Health
India/Arogyaan
Learning Objectives: 
  1. Describe the presenting features of Tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS)
  2. Describe the management of Tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS)

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References
  1. Colebunders R, John L, Huyst V, Kambugu A, Scano F, Lynen L. Tuberculosis immune reconstitution inflammatory syndrome in countries with limited resources. Int J Tuberc Lung Dis. 2006;10:946-53.
  2. Müller M, Wandel S, Colebunders R, Attia S, Furrer H, Egger M. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10:251-61.
  3. Pepper DJ, Marais S, Maartens G, et al. Neurologic manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome: a case series. Clin Infect Dis. 2009;48:e96-107.
  4. Breton G, Duval X, Estellat C, et al. Determinants of immune reconstitution inflammatory syndrome in HIV type 1-infected patients with tuberculosis after initiation of antiretroviral therapy. Clin Infect Dis. 2004;39:1709-12.
  5. Bourgarit A, Carcelain G, Martinez V, et al. Explosion of tuberculin-specific Th1-responses induces immune restoration syndrome in tuberculosis and HIV co-infected patients. AIDS. 2006;20:F1-7.
  6. Breen RA, Smith CJ, Bettinson H, et al. Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection. Thorax. 2004;59:704-7.
  7. Lawn SD, Bekker LG, Miller RF. Immune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis. 2005;5:361-73.
  8. Manabe YC, Campbell JD, Sydnor E, Moore RD. Immune reconstitution inflammatory syndrome: risk factors and treatment implications. J Acquir Immune Defic Syndr. 2007;46:456-62.
  9. Valin N, Pacanowski J, Denoeud L, et al. Risk factors for 'unmasking immune reconstitution inflammatory syndrome' presentation of tuberculosis following combination antiretroviral therapy initiation in HIV-infected patients. AIDS. 2010;24:1519-25
  10. Bhrushundi M, Mishra P. Study of immune reconstitution inflammatory syndrome (IRIS) in resource limited settings. XVI International AIDS Conference; Toronto, ON, Canada;2006. Abstract MOAB0305.
  11. Huyst V, Lynen L, Bottieau E, Zolfo M, Kestens L, Colebunders R. Immune reconstitution inflammatory syndrome in an HIV/TB co-infected patient four years after starting antiretroviral therapy. Acta Clin Belg. 2007;62:126-9.
  12. Murdoch DM, Venter WD, Van Rie A, Feldman C. Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options. AIDS Res Ther. 2007;4:9.
  13. Meintjes G, Lawn SD, Scano F, et al. Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings. Lancet Infect Dis. 2008;8:516-23.
  14. Manosuthi W, Van Tieu H, Mankatitham W, et al. Clinical case definition and manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. AIDS. 2009;23:2467-71.
  15. Haddow LJ, Moosa MY, Easterbrook PJ. Validation of a published case definition for tuberculosis-associated immune reconstitution inflammatory syndrome. AIDS. 2010;24:103-8.
  16. Eshun-Wilson I, Havers F, Nachega JB, et al. Evaluation of paradoxical TB-associated IRIS with the use of standardized case definitions for resource-limited settings. J Int Assoc Physicians AIDS Care (Chic). 2010;9:104-8.
  17. Abdool Karim SS, Naidoo K, Grobler A, et al. Integration of antiretroviral therapy with tuberculosis treatment. N Engl J Med. 2011;365:1492-501.
  18. Blanc FX, Sok T, Laureillard D, et al. Earlier versus later start of antiretroviral therapy in HIV-infected adults with tuberculosis. N Engl J Med. 2011;365:1471-81.
  19. Havlir DV, Kendall MA, Ive P, et al. Timing of antiretroviral therapy for HIV-1 infection and tuberculosis. N Engl J Med. 2011;365:1482-91.
  20. World Health Organization. Treatment of tuberculosis: guidelines – 4th edition. Geneva: WHO, 2010.
  21. World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach – 2010 revision. Geneva: WHO, 2010.
  22. Meintjes G, Wilkinson RJ, Morroni C, et al. Randomized placebo-controlled trial of prednisone for paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. AIDS. 2010;24:2381-90.
  23. Meintjes G, Rangaka MX, Maartens G, et al. Novel relationship between tuberculosis immune reconstitution inflammatory syndrome and antitubercular drug resistance. Clin Infect Dis. 2009;48:667-76.
  24. Robertson J, Meier M, Wall J, Ying J, Fichtenbaum CJ. Immune reconstitution syndrome in HIV: validating a case definition and identifying clinical predictors in persons initiating antiretroviral therapy. Clin Infect Dis. 2006;42:1639-46.