[Paradoxical aggravation of tuberculosis after antiretroviral therapy in HIV-infected patients].
BACKGROUND
Restoration of immunocompetence in HIV-infected patients after antiretroviral treatment can have unexpected effects.


METHODS
An unusual course of treated tuberculosis was observed in four HIV-infected patients soon after initiation of antiretroviral therapy. These patients developed fever and enlarged necrotic adenopathies despite an efficacious antituberculous therapy. They were in the initial stage of their antituberculous therapy that had been initiated a mean 12 days prior to initiation of antiretroviral therapy. The antiretroviral therapy led to an undetectable HIV load within 2 months.


CONCLUSIONS
These unusual features, which also occurred with an increase in CD4 cell counts, could be related to the immunological restoration and to the reappearance of delayed type hypersensitivity. The onset of antiretroviral therapy could thus be delayed by several weeks in HIV-infected patients treated for active tuberculosis and who have never received antiretroviral therapy.
Duval
X
X
Service des Maladies infectieuses et tropicales, Groupe Hospitalier Bichat-Claude Bernard, 46, rue Henri Huchard, F75877 Paris.
Trad
S
S
Le Moing
V
V
Longuet
P
P
Leport
C
C
Vildé
J L
JL
D000995:Antitubercular Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D014397:Tuberculosis, Pulmonary / Q000473:pathology*; D019562:Viral Load
D000995:Antitubercular Agents; D000998:Antiviral Agents