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Unmasking tb IRIS

Irene N Njuguna, Lisa M Cranmer, Vincent O Otieno, Cyrus Mugo, Hellen M Okinyi, Sarah Benki-Nugent, Barbra Richardson, Joshua Stern, Elizabeth Maleche-Obimbo, Dalton C Wamalwa, Grace C John-Stewart
BACKGROUND: Urgent antiretroviral therapy (ART) among hospitalised HIV-infected children might accelerate recovery or worsen outcomes associated with immune reconstitution. We aimed to compare urgent versus post-stabilisation ART among hospitalised HIV-infected children in Kenya. METHODS: In this unmasked randomised controlled trial, we randomly assigned (1:1) HIV-infected, ART-naive children aged 0-12 years who were eligible for treatment to receive ART within 48 h (urgent group) or in 7-14 days (post-stabilisation group) at four hospitals in Kenya (two in Nairobi and two in western Kenya)...
January 2018: Lancet HIV
Jose Armando Gonzales Zamora, Luis Alberto Espinoza, Rita N Nwanyanwu
Meningitis in individuals living with acquired immunodeficiency syndrome (AIDS) is most frequently infectious in origin and usually due to opportunistic infections. The most common pathogens are Cryptococcus neoformans and Mycobacterium tuberculosis. Treponema pallidum causes neurosyphilis and can complicate HIV infections at any time after the initial infection. Simultaneous infections of the central nervous system caused by these pathogens are very uncommon even in the setting of severe immunosuppression...
2017: Case Reports in Infectious Diseases
L W Preston Church, Amit Chopra, Marc A Judson
In HIV-infected individuals, paradoxical reactions after the initiation of antiretroviral therapy (ART) are associated with a variety of underlying infections and have been called the immune reconstitution inflammatory syndrome (IRIS). In cases of IRIS associated with tuberculosis (TB), two distinct patterns of disease are recognized: (i) the progression of subclinical TB to clinical disease after the initiation of ART, referred to as unmasking, and (ii) the progression or appearance of new clinical and/or radiographic disease in patients with previously recognized TB after the initiation of ART, the classic or "paradoxical" TB-IRIS...
March 2017: Microbiology Spectrum
S Cherif, K Yoganathan, T Banks, R Abdulla
Worldwide, it is estimated that 14.8% of all new tuberculosis cases in adults are attributable to HIV infection. Genitourinary tuberculosis is a known complication and is considered to be a severe form of extrapulmonary tuberculosis. Isolated tuberculous epididymo-orchitis is rare. We report a Caucasian HIV-positive heterosexual male with a clinical diagnosis of testicular tumour for which he underwent a right orchidectomy. Tuberculous epididymo-orchitis was confirmed by histology. In this case, all Immune Reconstitution Inflammatory Syndrome (IRIS) criteria were met...
January 2017: International Journal of STD & AIDS
Lucy C K Bell, Gabriele Pollara, Mellissa Pascoe, Gillian S Tomlinson, Rannakoe J Lehloenya, Jennifer Roe, Richard Meldau, Robert F Miller, Alan Ramsay, Benjamin M Chain, Keertan Dheda, Mahdad Noursadeghi
Increased risk of tuberculosis (TB) associated with HIV-1 infection is primarily attributed to deficient T helper (Th)1 immune responses, but most people with active TB have robust Th1 responses, indicating that these are not sufficient to protect against disease. Recent findings suggest that favourable outcomes following Mycobacterium tuberculosis infection arise from finely balanced inflammatory and regulatory pathways, achieving pathogen control without immunopathology. We hypothesised that HIV-1 and antiretroviral therapy (ART) exert widespread changes to cell mediated immunity, which may compromise the optimal host protective response to TB and provide novel insights into the correlates of immune protection and pathogenesis...
March 2016: PLoS Pathogens
Lokesh Shahani, Richard J Hamill
Immune reconstitution inflammatory syndrome (IRIS) is characterized by improvement in a previously incompetent human immune system manifesting as worsening of clinical symptoms secondary to the ability of the immune system to now mount a vigorous inflammatory response. IRIS was first recognized in the setting of human immunodeficiency virus, and this clinical setting continues to be where it is most frequently encountered. Hallmarks of the pathogenesis of IRIS, independent of the clinical presentation and the underlying pathogen, include excessive activation of the immune system, with increased circulating effector memory T cells, and elevated levels of serum cytokines and inflammatory markers...
January 2016: Translational Research: the Journal of Laboratory and Clinical Medicine
Hong Yien Tan, Yean Kong Yong, Bruno B Andrade, Esaki M Shankar, Sasheela Ponnampalavanar, Sharifah F S Omar, Gopalan Narendran, Adeeba Kamarulzaman, Soumya Swaminathan, Irini Sereti, Suzanne M Crowe, Martyn A French
BACKGROUND: Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is a substantial problem in HIV/TB coinfected patients commencing antiretroviral therapy (ART). The immunopathogenesis of TB-IRIS includes increased production of proinflammatory chemokines and cytokines, including interleukin-18, which is a signature cytokine of the nucleotide-binding domain and leucine-rich repeat pyrin containing protein-3 inflammasome. We compared plasma levels of interleukin-18 and other biomarkers of monocyte/macrophage activation in the prediction and characterization of TB-IRIS...
February 20, 2015: AIDS
(no author information available yet)
BACKGROUND: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis...
October 23, 2014: AIDS
Ruth Link-Gelles, Harry Moultrie, Shobna Sawry, David Murdoch, Annelies Van Rie
BACKGROUND: People with HIV initiating combination antiretroviral therapy are at risk for tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS). While this syndrome has been well researched in adults, little is known about the incidence, case fatality, underlying immunopathology and treatment approaches in children. METHODS: Major databases were searched for articles related to TB-IRIS in children. Data were abstracted using standardized forms...
May 2014: Pediatric Infectious Disease Journal
Rachel P J Lai, Justine K Nakiwala, Graeme Meintjes, Robert J Wilkinson
HIV-1 patients co-infected with some pathogens are at risk of developing the immune reconstitution inflammatory syndrome (IRIS) when initiating antiretroviral therapy (ART). IRIS is characterized by inflammation leading to the clinical worsening of a treated infection or the unmasking of a previously undiagnosed condition or infection. It is commonly associated with tuberculosis (TB), 8-43% of the HIV-TB co-infected patients prescribed with antitubercular treatment and ART develop TB-IRIS. Although IRIS has been recognized for over 20 years, relatively little was known until recently about its pathogenesis...
August 2013: European Journal of Immunology
Klaudija Viskovic, Josip Begovac
We describe two HIV-infected patients with tuberculosis-associated immune reconstruction inflammatory syndrome (TB-IRIS): one with "paradoxical" IRIS and the other with "unmasking" IRIS. TB-IRIS in HIV-infected subjects is an exacerbation of the symptoms, signs, or radiological manifestations of a pathogenic antigen, related to recovery of the immune system after immunosuppression. We focused on the radiological characteristics of TB-IRIS and the briefly literature review on this syndrome.
2013: Case Reports in Infectious Diseases
Lewis John Haddow, Mahomed-Yunus Suleman Moosa, Anisa Mosam, Pravi Moodley, Raveen Parboosing, Philippa Jane Easterbrook
BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) is a widely recognised complication of antiretroviral therapy (ART), but there are still limited data from resource-limited settings. Our objective was to characterize the incidence, clinical spectrum, risk factors and contribution to mortality of IRIS in two urban ART clinics in South Africa. METHODS AND FINDINGS: 498 adults initiating ART in Durban, South Africa were followed prospectively for 24 weeks...
2012: PloS One
María Asunción Vitoria, María González-Domínguez, Soledad Salvo, María José Crusells, Santiago Letona, Sofía Samper, Isabel Sanjoaquín
Highly active antiretroviral therapy in human immunodeficiency virus (HIV) patients may trigger the onset of immune reconstitution inflammatory syndrome (IRIS). Among HIV patients with IRIS, infections are commonly due to Mycobacterium tuberculosis and nontuberculous mycobacteria. We report the first case in Spain and the second in Europe of Mycobacterium simiae pulmonary infection unmasked during immune reconstitution in an HIV patient.
January 2013: Diagnostic Microbiology and Infectious Disease
Katalin A Wilkinson, Graeme Meintjes, Ronnett Seldon, Rene Goliath, Robert John Wilkinson
BACKGROUND: Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an early complication of combination antiretroviral therapy (cART). Two forms are recognised: (i) paradoxical - recurrent or new TB symptoms develop after cART initiation in patients receiving TB treatment prior to cART; and (ii) unmasking TB-IRIS - active TB presents within 3 months of cART in patients not receiving TB treatment at cART initiation. The latter has heightened clinical manifestations and a marked inflammatory presentation...
March 2, 2012: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Ronald van Toorn, Helena Rabie, Angela Dramowski, Johan F Schoeman
INTRODUCTION: Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is a potentially life-threatening complication in HIV infected children with tuberculosis (TB) of the central nervous system. HIV-associated TB-IRIS has not been previously described in children with neurotuberculosis. OBJECTIVE: To describe the neurological and neuro-radiological features of 4 consecutive cases of TB-IRIS in children with neurotuberculosis and to discuss possible management strategies...
November 2012: European Journal of Paediatric Neurology: EJPN
Julia del Amo, Santiago Moreno, Heiner C Bucher, Hansjakob Furrer, Roger Logan, Jonathan Sterne, Santiago Pérez-Hoyos, Inma Jarrín, Andrew Phillips, Sara Lodi, Ard van Sighem, Wolf de Wolf, Caroline Sabin, Loveleen Bansi, Amy Justice, Joseph Goulet, José M Miró, Elena Ferrer, Laurence Meyer, Rémonie Seng, Giota Toulomi, Panagiotis Gargalianos, Dominique Costagliola, Sophie Abgrall, Miguel A Hernán
BACKGROUND: The lower tuberculosis incidence reported in human immunodeficiency virus (HIV)-positive individuals receiving combined antiretroviral therapy (cART) is difficult to interpret causally. Furthermore, the role of unmasking immune reconstitution inflammatory syndrome (IRIS) is unclear. We aim to estimate the effect of cART on tuberculosis incidence in HIV-positive individuals in high-income countries. METHODS: The HIV-CAUSAL Collaboration consisted of 12 cohorts from the United States and Europe of HIV-positive, ART-naive, AIDS-free individuals aged ≥18 years with baseline CD4 cell count and HIV RNA levels followed up from 1996 through 2007...
May 2012: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Erik A Guevara-Silva, María A Ramírez-Crescencio, José Luís Soto-Hernández, Graciela Cárdenas
BACKGROUND: Highly active antiretroviral therapy (HAART) restores the inflammatory immune response in AIDS patients and it may unmask previous subclinical infections or paradoxically exacerbate symptoms of opportunistic infections. Up to 25% of patients receiving HAART develop immune reconstitution inflammatory syndrome (IRIS). We describe six patients with IRIS central nervous system (CNSIRIS) manifestations emphasizing the relevance of CSF cultures and neuroimaging in early diagnosis and management...
September 2012: Clinical Neurology and Neurosurgery
D Huis in 't Veld, H-Y Sun, C-C Hung, R Colebunders
The immune reconstitution inflammatory syndrome (IRIS) is a consequence of an excessive pathogen-specific immune recovery reaction and occurs in a subset of patients on antiretroviral therapy (ART). Infective forms of IRIS may present either as an 'unmasking' of a previously subclinical infection or the paradoxical clinical deterioration of an infection for which the patient received appropriate antimicrobial therapy. The most important risk factors for IRIS are a low CD4+ T-cell count and a short time between treatment of the infection and the commencement of ART...
June 2012: European Journal of Clinical Microbiology & Infectious Diseases
Francesca Conradie, Andrea S Foulkes, Prudence Ive, Xiangfan Yin, Katerina Roussos, Deborah K Glencross, Denise Lawrie, Wendy Stevens, Luis J Montaner, Ian Sanne, Livio Azzoni
BACKGROUND: With increased access to antiretroviral treatment (ART), immune reconstitution inflammatory syndrome (IRIS) in Mycobacterium tuberculosis (MTB)-infected populations remains a clinical challenge. We studied a cross-sectional cohort of HIV-infected subjects in Johannesburg (South Africa) to help define the immune correlates that best distinguish IRIS from ongoing MTB cases. METHODS: We studied HIV+ subjects developing MTB-related unmasking tuberculosis-related immune reconstitution inflammatory syndrome (uTB-IRIS) after ART initiation; control groups were subjects with HIV and HIV/tuberculosis-coinfected subjects with comparable ART treatment...
November 1, 2011: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Kedir Ali, Stephen A Klotz
The Immune Reconstitution Inflammatory Syndrome (IRIS) in Ethiopian HIV-infected patients coinfected with tuberculosis (TB) was studied. HIV-infected outpatients initiating antiretroviral therapy (ART) at an HIV clinic in northern Ethiopia from January 2007 through September 2008 were identified (n = 1977). Patients with TB-IRIS occurring within 6 months of starting ART (n = 143) were compared with a control group of patients with HIV who began ART but did not develop TB-IRIS (n = 277). ART was not interrupted in any patient...
May 2012: Journal of the International Association of Physicians in AIDS Care: JIAPAC
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