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Paradoxical reactions and immune reconstitution inflammatory syndrome in tuberculosis

Bell, LCK; Breen, R; Miller, RF; Noursadeghi, M; Lipman, M; (2015) Paradoxical reactions and immune reconstitution inflammatory syndrome in tuberculosis. International Journal of Infectious Diseases , 32 pp. 39-45. 10.1016/j.ijid.2014.12.030. Green open access

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Abstract

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 ofthese 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.

Type: Article
Title: Paradoxical reactions and immune reconstitution inflammatory syndrome in tuberculosis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ijid.2014.12.030
Publisher version: http://dx.doi.org/10.1016/j.ijid.2014.12.030
Language: English
Additional information: 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).
Keywords: Science & technology, life sciences & biomedicine, infectious diseases, paradoxical reaction, iris, tuberculosis, hiv, mycobacteria, immune reconstitution, hiv-infected patients, active antiretroviral therapy, lymph-node tuberculosis, cd4(+) t-cells, risk-factors, restoration syndrome, negative patients, antituberculosis treatment, mycobacterial infections, hiv-1-infected patients.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1464437
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