Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease
Antiretroviral therapy (ART), while essential in combatting tuberculosis (TB) and HIV coinfection, is often complicated by the TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). Depending on the TB disease site and treatment status at ART initiation, this immune-mediated worsening...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-10-01
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| Series: | Life |
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| Online Access: | https://www.mdpi.com/2075-1729/10/11/262 |
| _version_ | 1797549477258592256 |
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| author | Carson M. Quinn Victoria Poplin John Kasibante Kyle Yuquimpo Jane Gakuru Fiona V. Cresswell Nathan C. Bahr |
| author_facet | Carson M. Quinn Victoria Poplin John Kasibante Kyle Yuquimpo Jane Gakuru Fiona V. Cresswell Nathan C. Bahr |
| author_sort | Carson M. Quinn |
| collection | DOAJ |
| description | Antiretroviral therapy (ART), while essential in combatting tuberculosis (TB) and HIV coinfection, is often complicated by the TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). Depending on the TB disease site and treatment status at ART initiation, this immune-mediated worsening of TB pathology can take the form of paradoxical TB-IRIS, unmasking TB-IRIS, or CNS TB-IRIS. Each form of TB-IRIS has unique implications for diagnosis and treatment. Recently published studies have emphasized the importance of neutrophils and T cell subtypes in TB-IRIS pathogenesis, alongside the recognized role of CD4 T cells and macrophages. Research has also refined our prognostic understanding, revealing how the disease can impact lung function. While corticosteroids remain the only trial-supported therapy for prevention and management of TB-IRIS, increasing interest has been given to biologic therapies directly targeting the immune pathology. TB-IRIS, especially its unmasking form, remains incompletely described and more data is needed to validate biomarkers for diagnosis. Management strategies remain suboptimal, especially in the highly morbid central nervous system (CNS) form of the disease, and further trials are necessary to refine treatment. In this review we will summarize the current understanding of the immunopathogenesis, the presentation of TB-IRIS and the evidence for management recommendations. |
| first_indexed | 2024-03-10T15:15:10Z |
| format | Article |
| id | doaj.art-c92dae97c3214427b5d0dda6d522da6c |
| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-10T15:15:10Z |
| publishDate | 2020-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj.art-c92dae97c3214427b5d0dda6d522da6c2023-11-20T19:00:57ZengMDPI AGLife2075-17292020-10-01101126210.3390/life10110262Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of DiseaseCarson M. Quinn0Victoria Poplin1John Kasibante2Kyle Yuquimpo3Jane Gakuru4Fiona V. Cresswell5Nathan C. Bahr6School of Medicine, University of California, San Francisco, CA 94143, USADivision of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS 66045, USAInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaDepartment of Medicine, University of Kansas, Kansas City, KS 66045, USAInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaDivision of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS 66045, USAAntiretroviral therapy (ART), while essential in combatting tuberculosis (TB) and HIV coinfection, is often complicated by the TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). Depending on the TB disease site and treatment status at ART initiation, this immune-mediated worsening of TB pathology can take the form of paradoxical TB-IRIS, unmasking TB-IRIS, or CNS TB-IRIS. Each form of TB-IRIS has unique implications for diagnosis and treatment. Recently published studies have emphasized the importance of neutrophils and T cell subtypes in TB-IRIS pathogenesis, alongside the recognized role of CD4 T cells and macrophages. Research has also refined our prognostic understanding, revealing how the disease can impact lung function. While corticosteroids remain the only trial-supported therapy for prevention and management of TB-IRIS, increasing interest has been given to biologic therapies directly targeting the immune pathology. TB-IRIS, especially its unmasking form, remains incompletely described and more data is needed to validate biomarkers for diagnosis. Management strategies remain suboptimal, especially in the highly morbid central nervous system (CNS) form of the disease, and further trials are necessary to refine treatment. In this review we will summarize the current understanding of the immunopathogenesis, the presentation of TB-IRIS and the evidence for management recommendations.https://www.mdpi.com/2075-1729/10/11/262tuberculosisimmune reconstitution inflammatory syndrometuberculous meningitisacquired immunodeficiency syndrome |
| spellingShingle | Carson M. Quinn Victoria Poplin John Kasibante Kyle Yuquimpo Jane Gakuru Fiona V. Cresswell Nathan C. Bahr Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease Life tuberculosis immune reconstitution inflammatory syndrome tuberculous meningitis acquired immunodeficiency syndrome |
| title | Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease |
| title_full | Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease |
| title_fullStr | Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease |
| title_full_unstemmed | Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease |
| title_short | Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease |
| title_sort | tuberculosis iris pathogenesis presentation and management across the spectrum of disease |
| topic | tuberculosis immune reconstitution inflammatory syndrome tuberculous meningitis acquired immunodeficiency syndrome |
| url | https://www.mdpi.com/2075-1729/10/11/262 |
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