Diagnosis and Management of Paradoxical TB-IRIS
Literature Review
DOI:
https://doi.org/10.55175/cdk.v52i10.1544Keywords:
HIV, IRIS, TB-IRIS, tuberculosisAbstract
Tuberculosis (TB) is the most common opportunistic infection in patients with human immunodeficiency virus (HIV). TB-HIV is a global burden, especially in TB endemic countries, such as Indonesia, and increased mortality. Patients with HIV need antiretroviral drugs treatment as early as possible but comorbidity with TB carries a high-risk of immune reconstitution inflammatory syndrome (IRIS), which can worsen clinical condition and increase the mortality rate. TB-IRIS is divided into 2 categories, namely paradoxical TB-IRIS in patients who have previously received TB therapy and unmasking TB-IRIS in patients newly diagnosed with TB after initiation of ARV. Clinical manifestations of TB-IRIS include worsening respiratory and constitutional symptoms, as well as the appearance of new lesions in other organs. The diagnosis of TB-IRIS requires the exclusion of other conditions such as opportunistic infections or TB treatment failure. Prevention strategies include TB screening before ARV initiation, selection of the appropriate timing for ARV administration, and the use of corticosteroids such as prednisone to reduce the risk of worsening. Management of TB-IRIS focuses on supportive therapy, inflammation control, and continuation of ARV and OAT treatment. With early detection, prevention, and appropriate management, morbidity and mortality rates due to TB-IRIS can be significantly reduced.
Downloads
References
Blanc FX, Badje AD, Bonnet M, Gabillard D, Messou E, Muzoora C, et al. Systematic or test-guided treatment for tuberculosis in HIV-infected adults. N Engl J Med. 2020;382(25):2397–410. doi: 10.1056/NEJMoa1910708.
Le X, Shen Y. Advances in antiretroviral therapy for patients with human immunodefciency virus-associated tuberculosis. Viruses 2024;16(4):494. doi: 10.3390/v16040494.
Chelkeba L, Fekadu G, Tesfaye G, Belayneh F, Melaku T, Mekonnen Z. Efects of time of initiation of antiretroviral therapy in the treatment of patients with HIV/TB co-infection: a systemic review and meta-analysis. Ann Med Surg. 2020;55(April):148–58. https://doi.org/10.1016/j.amsu.2020.05.004.
Cevaal PM, Bekker LG, Hermans S. TB-IRIS pathogenesis and new strategies for intervention: Insights from related infammatory disorders. Tuberculosis 2019;118(September):101863. https://doi.org/10.1016/j.tube.2019.101863.
Vinhaes CL, Araujo-Pereira M, Tiburcio R, Cubillos-Angulo JM, Demitto FO, Akrami KM, et al. Systemic infammation associated with immune reconstitution infammatory syndrome in persons living with hiv. Life (Basel). 2021 Jan 18;11(1):65. doi: 10.3390/life11010065.
Gaillet A, Calin R, Flandre P, Tubiana R, Valantin MA, Caumes E, et al. Increased risk of IRIS-associated tuberculosis in HIV-infected patients receiving Integrase Inhibitors. Infect Dis Now. 2021 Feb;51(1):90-3. doi: 10.1016/j.medmal.2020.09.005.
Narendran G, Jyotheeswaran K, Senguttuvan T, Vinhaes CL, Santhanakrishnan RK, Manoharan T, et al. Characteristics of paradoxical tuberculosis-associated immune reconstitution infammatory syndrome and its infuence on tuberculosis treatment outcomes in persons living with HIV. Int J Infect Dis. 2020;98:261–7. https://doi.org/10.1016/j.ijid.2020.06.097.
Lanzafame M, Vento S. Tuberculosis-immune reconstitution infammatory syndrome. J Clin Tuberc Other Mycobact Dis. 2016;3:6–9. http://dx.doi.org/10.1016/j.jctube.2016.03.002.
Suryana K. A challenge in diagnosis of tuberculosisassociated immune reconstitution infammatory syndrome (Tb-iris). HIV AIDS (Auckl). 2020 Jul 21;12:263–9. doi: 10.2147/HIV.S254105.
Nayak B, Panda RK, Mohanty T, Sahu L. Incidence and pattern of tuberculosis immune reconstitution infammatory syndrome (TB-IRIS) in patients on anti-retroviral therapy: an observational study. Indian J Tuberc. 2023;(xxxx):1–6. https://doi.org/10.1016/j.ijtb.2023.05.015.
Quinn CM, Poplin V, Kasibante J, Yuquimpo K, Gakuru J, Cresswell F V, et al. Tuberculosis iris: pathogenesis, presentation, and management across the spectrum of disease. Life (Basel). 2020 Oct 29;10(11):262. doi: 10.3390/life10110262.
Coelho LE, Chazallon C, Laureillard D, Escada R, N’Takpe JB, Timana I, et al. Incidence and predictors of tuberculosis-associated IRIS in people with HIV treated for tuberculosis: fndings from refate TB2 randomized trial. Open Forum Infect Dis. 2024;11(3):1–9. https://doi.org/10.1093/ofd/ofae035.
Goletti D, Pisapia R, Fusco FM, Aiello A, Van Crevel R. Epidemiology, pathogenesis, clinical presentation and management of TB in patients with HIV and diabetes. Int J Tuberc Lung Dis. 2023 Apr 1;27(4):284-90. doi: 10.5588/ijtld.22.0685.
Gupta P, Tripathi AK, Singh KP, Jain A. Deciphering TB-IRIS in HIV patients: a comprehensive clinical and microbiological analysis. MedRxiv [Internet]. 2024. Available from: https://www.medrxiv.org/content/10.1101/2024.09.10.24313396v1.full.pdf.
Mahadita GW, Somia IA. Patogenesis dan diagnosis immune reconstitution infammatory syndrome tuberculosis. Intisari Sains Medis 2020;11(3):1492–9. doi: 10.15562/ism.v11i3.863.
Stek C, Buyze J, Menten J, Schutz C, Thienemann F, Blumenthal L, et al. Diagnostic accuracy of the INSHI consensus case defnition for the diagnosis of paradoxical tuberculosis-IRIS. J Acquir Immune Defc Syndr. 2021 Apr 15;86(5):587-92. doi: 10.1097/QAI.0000000000002606.
Wasserman S, Barr D, Meintjes G. Clinical manifestations of HIV-associated tuberculosis in adults. HIV and tuberculosis: a formidable alliance. Cham: Springer International Publishing; 2019. p. 73–97. doi:10.1007/978-3-030-29108-2_5.
Bana TM, Lesosky M, Pepper DJ, Plas H Van Der, Schutz C, Goliath R, et al. Prolonged tuberculosis-associated immune reconstitution infammatory syndrome: characteristics and risk factors. BMC Infectious Diseases 2016;16:518. doi: 10.1186/s12879-016-1850-2.
Yang Q, Han J, Shen J, Peng X, Zhou L, Yin X. Diagnosis and treatment of tuberculosis in adults with HIV. Med (United States). 2022;101(35):E30405. doi: 10.1097/MD.0000000000030405.
Meintjes G, Scriven J, Marais S. Management of the immune reconstitution infammatory syndrome. Curr HIV/AIDS Rep. 2012;9(3):238–50. doi: 10.1007/s11904-012-0129-5.
Meintjes G, Stek C, Blumenthal L, Thienemann F, Schutz C, Buyze J, et al. Prednisone for the prevention of paradoxical tuberculosis-associated IRIS. N Engl J Med. 2018;379(20):1915–25. doi: 10.1056/NEJMoa1800762.
Wouters E, Stek C, Swartz A, Buyze J, Schutz C, Thienemann F, et al. Prednisone for the prevention of tuberculosis-associated IRIS (randomized controlled trial): impact on the health-related quality of life. Front Psychol. 2022;13(October):1–13. doi: 10.3389/fpsyg.2022.983028.
Stek C, Allwood B, Bruyn E Du, Buyze J, Schutz C, Thienemann F, et al. The efect of HIV-associated tuberculosis, tuberculosis-IRIS and prednisone on lung function. Eur Respir J. 2020;55(3):0–9. http://dx.doi.org/10.1183/13993003.01692-2019.
Ayelign B, Workneh M, Molla MD, Dessie G. Role of vitamin-D supplementation in TB/HIV co-infected patients. Infect Drug Resist. 2020;13:111–8. doi: 10.2147/IDR.S228336.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Yovita Gotama, Ketut Suryana
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
