title: Treatment for tuberculosis-associated immune reconstitution inflammatory syndrome in 34 HIV-infected patients.
abstract: BACKGROUND
  Paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) frequently follows the initiation of antiretroviral therapy (ART) in patients with tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection. Treatment recommendations are nearly exclusively  based on expert opinion.
  
  
  OBJECTIVE
  To assess the clinical outcomes of patients treated using various strategies for TB-IRIS.
  
  
  METHODS
  In a retrospective analysis of patients treated in Paris hospitals from 1996 to 2008, we describe TB-IRIS outcome, frequency of relapses and CD4 cell  count changes after 12 months of ART for the following strategies: no treatment, interrupted ART and use of steroids.
  
  
  RESULTS
  Among 34 patients, TB-IRIS outcome was favourable in 10/10 with no treatment, 11/13 with ART interruption, 3/3 with ART interruption and simultaneous use of steroids  and 8/8 with steroids alone. Relapses were observed in both the ART interruption (6/13, 46%) and steroids (4/8, 50%) groups, but were less frequent in the no-treatment group (1/10, 10%). Steroids were prescribed in 61% of the patients and had no significant side effects; steroid use was associated  with a trend towards a lower median CD4 cell count at 12 months of ART compared to the others (230 vs. 322 cells/mm(3)), despite no baseline differences.
  
  
  CONCLUSIONS
  TB-IRIS outcome was favourable regardless of the therapeutic strategies employed. Although steroids were widely  used and well-tolerated, an initial wait-and-see attitude in the case of non-severe IRIS remains an interesting strategy to be evaluated.
authors.affiliation: Department of Internal Medicine, Paris VI University, Hôpital Pitié-Salpêtrière, Paris, France. guillaume.breton@psl.aphp.fr
authors.forename: G
authors.initials: G
authors.lastname: Breton
authors.forename: A
authors.initials: A
authors.lastname: Bourgarit
authors.forename: S
authors.initials: S
authors.lastname: Pavy
authors.forename: D
authors.initials: D
authors.lastname: Bonnet
authors.forename: V
authors.initials: V
authors.lastname: Martinez
authors.forename: X
authors.initials: X
authors.lastname: Duval
authors.forename: P
authors.initials: P
authors.lastname: Longuet
authors.forename: S
authors.initials: S
authors.lastname: Abgrall
authors.forename: A
authors.initials: A
authors.lastname: Simon
authors.forename: C
authors.initials: C
authors.lastname: Leport
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D005260:Female; D005500:Follow-Up Studies; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents