PMID- 25809754
OWN - NLM
STAT- MEDLINE
DCOM- 20160212
LR  - 20181202
IS  - 1878-3511 (Electronic)
IS  - 1201-9712 (Linking)
VI  - 32
DP  - 2015 Mar
TI  - Paradoxical reactions and immune reconstitution inflammatory syndrome in 
      tuberculosis.
PG  - 39-45
LID - S1201-9712(14)01748-2 [pii]
LID - 10.1016/j.ijid.2014.12.030 [doi]
AB  - The coalescence of the HIV-1 and tuberculosis (TB) epidemics in Sub-Saharan 
      Africa has had a significant and negative impact on global health. The 
      availability of effective antimicrobial treatment for both HIV-1 (in the form of 
      highly active antiretroviral therapy (HAART)) and TB (with antimycobacterial 
      agents) has the potential to mitigate the associated morbidity and mortality. 
      However, the use of both HAART and antimycobacterial therapy is associated with 
      the development of inflammatory paradoxical syndromes after commencement of 
      therapy. These include paradoxical reactions (PR) and immune reconstitution 
      inflammatory syndromes (IRIS), conditions that complicate mycobacterial disease 
      in HIV seronegative and seropositive individuals. Here, we discuss case 
      definitions for PR and IRIS, and explore how advances in identifying the risk 
      factors and immunopathogenesis of these conditions informs our understanding of 
      their shared underlying pathogenesis. We propose that both PR and IRIS are 
      characterized by the triggering of exaggerated inflammation in a setting of 
      immunocompromise and antigen loading, via the reversal of immunosuppression by 
      HAART and/or antimycobacterials. Further understanding of the molecular basis of 
      this pathogenesis may pave the way for effective immunotherapies for the 
      treatment of PR and IRIS.
CI  - Copyright (c) 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.
FAU - Bell, Lucy C K
AU  - Bell LC
AD  - Division of Infection and Immunity, Cruciform Building, University College 
      London, Gower Street, London WC1E 6BT, UK. Electronic address: 
      lucy.bell.09@ucl.ac.uk.
FAU - Breen, Ronan
AU  - Breen R
AD  - Department of Respiratory Medicine, Guys and St Thomas' NHS Foundation Trust, 
      London, UK.
FAU - Miller, Robert F
AU  - Miller RF
AD  - Research Department of Infection and Population Health, Institute of Epidemiology 
      and Healthcare, University College London, London, UK.
FAU - Noursadeghi, Mahdad
AU  - Noursadeghi M
AD  - Division of Infection and Immunity, Cruciform Building, University College 
      London, Gower Street, London WC1E 6BT, UK.
FAU - Lipman, Marc
AU  - Lipman M
AD  - Centre for Respiratory Medicine, Royal Free London NHS Foundation Trust, 
      University College London, London, UK.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Canada
TA  - Int J Infect Dis
JT  - International journal of infectious diseases : IJID : official publication of the 
      International Society for Infectious Diseases
JID - 9610933
SB  - IM
MH  - Antiretroviral Therapy, Highly Active/adverse effects
MH  - Coinfection/complications
MH  - HIV Infections/complications/drug therapy
MH  - HIV-1
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*etiology/immunology
MH  - Male
MH  - Risk Factors
MH  - Tuberculosis/*complications/drug therapy
OTO - NOTNLM
OT  - HIV
OT  - IRIS
OT  - Immune reconstitution
OT  - Mycobacteria
OT  - Paradoxical reaction
OT  - Tuberculosis
EDAT- 2015/03/27 06:00
MHDA- 2016/02/13 06:00
CRDT- 2015/03/27 06:00
PHST- 2014/11/17 00:00 [received]
PHST- 2014/12/15 00:00 [revised]
PHST- 2014/12/16 00:00 [accepted]
PHST- 2015/03/27 06:00 [entrez]
PHST- 2015/03/27 06:00 [pubmed]
PHST- 2016/02/13 06:00 [medline]
AID - S1201-9712(14)01748-2 [pii]
AID - 10.1016/j.ijid.2014.12.030 [doi]
PST - ppublish
SO  - Int J Infect Dis. 2015 Mar;32:39-45. doi: 10.1016/j.ijid.2014.12.030.