The immunopathogenesis of the HIV tuberculosis immune reconstitution inflammatory syndrome.
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. Despite these advances in understanding IRIS, there remains no immune biomarker for diagnostic or prognostic purposes. Here, we review the risk factors associated with TB-IRIS, the challenges in studying this syndrome, and how T lymphocytes, dysregulated cytokine responses, and innate immunity may contribute to the development of TB-IRIS.
MRC National Institute for Medical Research, London, UK.
Rachel P J
RP
Lai
Justine K
JK
Nakiwala
Graeme
G
Meintjes
Robert J
RJ
Wilkinson
D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D060085:Coinfection; D016207:Cytokines / Q000378:metabolism; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D015497:HIV-1; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis / Q000276:immunology*; D012307:Risk Factors; D016176:T-Lymphocyte Subsets / Q000276:immunology; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000276:immunology*
D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents; D015415:Biomarkers; D016207:Cytokines
Drug therapy complications; HIV-1 infection; Immune reconstitution inflammatory syndrome; Tuberculosis