title: Paradoxical TB-IRIS in HIV-infected adults: a systematic review and meta-analysis.
abstract: Paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) was first described almost two decades ago. We undertook this systematic review and meta-analysis to collate findings across studies that have reported the incidence, clinical features, management and outcomes of paradoxical TB-IRIS. Forty studies that cumulatively reported 1048 paradoxical TB-IRIS cases were included. The pooled estimated incidence among patients with HIV-associated TB initiating antiretroviral therapy was 18% (95% CI: 16-21%). Frequent features were pulmonary and lymph node involvement. Hospitalization occurred in 25% (95% CI: 19-30%). In studies that reported treatment, corticosteroids were prescribed more frequently (38%; 95% CI: 27-48%) than nonsteroidal anti-inflammatory drugs (28%; 95% CI: 2-53%). Case fatality was 7% (95% CI: 4-11%), but death attributed to TB-IRIS occurred in 2% of cases (95% CI: 1-3%).
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Phiona E
authors.initials: PE
authors.lastname: Namale
authors.affiliation: Vaccines for Africa Initiative, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Leila H
authors.initials: LH
authors.lastname: Abdullahi
authors.affiliation: Department of Medicine, New Somerset Hospital, Cnr Beach & Lower Portswood Road, Green Point, Cape Town 8001, Western Cape, South Africa.
authors.forename: Stacey
authors.initials: S
authors.lastname: Fine
authors.affiliation: Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Monika
authors.initials: M
authors.lastname: Kamkuemah
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa.|Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease & Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.|Department of Medicine, Imperial College London, W2 1PG, UK.|Medical Research Council, National Institute of Medical Research, London, NW7 1AA, UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wilkinson
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa.|Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease & Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.|Department of Medicine, Imperial College London, W2 1PG, UK.
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D015994:Incidence; D008875:Middle Aged; D009026:Mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000893:Anti-Inflammatory Agents
keywords: HIV; IRIS; antiretroviral therapy; immune reconstitution inflammatory syndrome; paradoxical; tuberculosis