title: Unmasked tuberculosis and tuberculosis immune reconstitution inflammatory disease: a disease spectrum after initiation of antiretroviral therapy.
abstract: Antiretroviral therapy (ART) has beneficial effects on mortality and lowers the incidence of diseases caused by opportunistic infections, such as tuberculosis (TB). Although ART has sustained long-term benefits, the risk of TB is high during the first 3 months after ART initiation. Among cases of ART-associated TB, we define "unmasked TB" as that which occurs in patients with reactivation disease who develop clinically recognizable TB after ART with the restoration of previously acquired TB antigen-specific functional immune responses. TB cases with clinical evidence of an inflammatory syndrome are a subset of these unmasked cases, which we define as "unmasked TB-immune reconstitution inflammatory syndrome." With more widespread use of ART in areas with a high prevalence of TB, unmasked TB will likely become more common. TB diagnostics with improved sensitivity and specificity are urgently needed to detect subclinical TB before it is unmasked.
authors.affiliation: Center for Tuberculosis Research, Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA. ymanabe@jhmi.edu
authors.forename: Yukari C
authors.initials: YC
authors.lastname: Manabe
authors.forename: Ronan
authors.initials: R
authors.lastname: Breen
authors.forename: Tara
authors.initials: T
authors.lastname: Perti
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
mesh_terms: D000328:Adult; D000818:Animals; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000276:immunology; D000995:Antitubercular Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications*; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008954:Models, Biological; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000276:immunology
chemical_list: D044966:Anti-Retroviral Agents; D000942:Antigens, Bacterial; D000995:Antitubercular Agents; D007538:Isoniazid