PMID- 32631210
OWN - NLM
STAT- MEDLINE
DCOM- 20210412
LR  - 20210412
IS  - 1758-1052 (Electronic)
IS  - 0956-4624 (Print)
IS  - 0956-4624 (Linking)
VI  - 31
IP  - 8
DP  - 2020 Jul
TI  - Anakinra in the treatment of protracted paradoxical inflammatory reactions in 
      HIV-associated tuberculosis in the United Kingdom: a report of two cases.
PG  - 808-812
LID - 10.1177/0956462420915394 [doi]
AB  - Paradoxical reactions, including immune reconstitution inflammatory syndrome 
      (IRIS), are common in patients co-infected with human immunodeficiency virus 
      (HIV) and tuberculosis (TB). Paradoxical reactions may confer substantial 
      morbidity and mortality, especially in cases of central nervous system (CNS) TB, 
      or through protracted usage of corticosteroids. No high-quality evidence is 
      available to guide management in this scenario. Interleukin-1-mediated 
      inflammation has been implicated in the pathophysiology of TB-IRIS. We describe 
      two cases where anakinra (human recombinant interleukin-1 receptor antagonist) 
      was used as steroid-sparing therapy for life-threatening protracted paradoxical 
      inflammation in HIV-associated TB. In the first case of disseminated TB with 
      lymphadenitis, protracted TB-IRIS led to amyloid A amyloidosis and nephrotic 
      syndrome. In the second case of disseminated TB with cerebral tuberculomata, 
      paradoxical inflammation caused unstable tuberculomata leading to profound 
      neuro-disability. In both cases, paradoxical inflammation persisted for over a 
      year. Protracted high-dose corticosteroid use led to adverse events yet failed to 
      control inflammatory pathology. In both patients, anakinra successfully 
      controlled paradoxical inflammation and facilitated withdrawal of corticosteroid 
      therapy. Following anakinra therapy, nephrotic syndrome and neuro-disability 
      resolved, respectively. Anakinra therapy for protracted paradoxical inflammation 
      in HIV-associated TB may be a viable therapeutic option and warrants further 
      research.
FAU - Keeley, Alexander J
AU  - Keeley AJ
AUID- ORCID: 0000-0001-9386-1157
AD  - Department of Infection, Immunity and Cardiovascular Disease and Florey 
      Institute, University of Sheffield, Sheffield, UK.
FAU - Parkash, Vivak
AU  - Parkash V
AD  - Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS 
      Foundation Trust, Sheffield, UK.
FAU - Tunbridge, Anne
AU  - Tunbridge A
AD  - Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS 
      Foundation Trust, Sheffield, UK.
FAU - Greig, Julia
AU  - Greig J
AD  - Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS 
      Foundation Trust, Sheffield, UK.
FAU - Collini, Paul
AU  - Collini P
AUID- ORCID: 0000-0001-6696-6826
AD  - Department of Infection, Immunity and Cardiovascular Disease and Florey 
      Institute, University of Sheffield, Sheffield, UK.
FAU - McKane, William
AU  - McKane W
AD  - Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, 
      Sheffield, UK.
FAU - Tattersall, Rachel S
AU  - Tattersall RS
AD  - Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust and 
      Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Int J STD AIDS
JT  - International journal of STD & AIDS
JID - 9007917
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Antitubercular Agents)
RN  - 0 (Interleukin 1 Receptor Antagonist Protein)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/complications/epidemiology/*immunology
MH  - Adult
MH  - Anti-HIV Agents/therapeutic use
MH  - Antitubercular Agents/therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Coinfection/*drug therapy
MH  - Female
MH  - HIV Infections/*complications/drug therapy/epidemiology
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/drug therapy/*immunology
MH  - Interleukin 1 Receptor Antagonist Protein/*therapeutic use
MH  - Male
MH  - Treatment Outcome
MH  - Tuberculosis, Pulmonary/complications/drug therapy/*immunology
MH  - United Kingdom
PMC - PMC7590809
OTO - NOTNLM
OT  - Tuberculosis
OT  - anakinra
OT  - human immunodeficiency virus
OT  - immune reconstitution inflammatory syndrome
OT  - paradoxical inflammatory reactions
COIS- The authors declared no potential conflicts of interest with respect to the 
      research, authorship, and/or publication of this article.
EDAT- 2020/07/08 06:00
MHDA- 2021/04/13 06:00
PMCR- 2020/10/27
CRDT- 2020/07/08 06:00
PHST- 2020/07/08 06:00 [entrez]
PHST- 2020/07/08 06:00 [pubmed]
PHST- 2021/04/13 06:00 [medline]
PHST- 2020/10/27 00:00 [pmc-release]
AID - 10.1177_0956462420915394 [pii]
AID - 10.1177/0956462420915394 [doi]
PST - ppublish
SO  - Int J STD AIDS. 2020 Jul;31(8):808-812. doi: 10.1177/0956462420915394.