Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings

Lancet Infect Dis. 2008 Aug;8(8):516-23. doi: 10.1016/S1473-3099(08)70184-1.

Abstract

The immune reconstitution inflammatory syndrome (IRIS) has emerged as an important early complication of antiretroviral therapy (ART) in resource-limited settings, especially in patients with tuberculosis. However, there are no consensus case definitions for IRIS or tuberculosis-associated IRIS. Moreover, previously proposed case definitions are not readily applicable in settings where laboratory resources are limited. As a result, existing studies on tuberculosis-associated IRIS have used a variety of non-standardised general case definitions. To rectify this problem, around 100 researchers, including microbiologists, immunologists, clinicians, epidemiologists, clinical trialists, and public-health specialists from 16 countries met in Kampala, Uganda, in November, 2006. At this meeting, consensus case definitions for paradoxical tuberculosis-associated IRIS, ART-associated tuberculosis, and unmasking tuberculosis-associated IRIS were derived, which can be used in high-income and resource-limited settings. It is envisaged that these definitions could be used by clinicians and researchers in a variety of settings to promote standardisation and comparability of data.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / microbiology
  • Anti-HIV Agents / therapeutic use*
  • Antitubercular Agents / therapeutic use
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / immunology
  • Health Resources
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / diagnosis*
  • Immune Reconstitution Inflammatory Syndrome / immunology
  • Immune Reconstitution Inflammatory Syndrome / physiopathology*
  • Male
  • Middle Aged
  • Poverty
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / immunology*
  • Tuberculosis, Pulmonary / physiopathology*

Substances

  • Anti-HIV Agents
  • Antitubercular Agents