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Updated: Sep 18, 2026
Processing of Bronchoalveolar Lavage Fluid and Matched Blood for Alveolar Macrophage and CD4+ T-cell Immunophenotyping and HIV Reservoir Assessment
Published on: June 23, 2019
Tuberculosis-associated immune reconstitution inflammatory syndrome in patients living with HIV-1: a 15-year
Aida Zaghdoudi1, Souhail Zayet2, Ilhem Boutiba3
1Infectious Diseases Department, University Hospital Clermont-Ferrand, Clermont-Ferrand, France.
Background:
The initiation of antiretroviral therapy in people co-infected with HIV and tuberculosis (TB) may trigger TB-associated immune reconstitution inflammatory syndrome (TB-IRIS), a condition associated with a significant morbidity and mortality.
Methods:
We conducted a retrospective study of patients co-infected with HIV and TB over 15 years, with the aim to describe the clinical characteristics of patients who developed TB-IRIS and to identify factors predictive of its occurrence.
Results:
Overall, 28 of the 123 patients (22.8%) developed TB-IRIS, including 18 cases of paradoxical TB-IRIS among 89 patients at risk (20.2%) and 10 cases of unmasking TB-IRIS among 34 patients at risk (29.4%). The most frequent TB sites were lymph nodes (n = 17, 61%), the central nervous system (CNS) (n = 5, 18%), and lungs (n = 5, 18%). Corticosteroids were administered to 9 patients (32%). Eight deaths (29%) occurred in patients with TB-IRIS. In univariate analysis, factors associated with paradoxical TB-IRIS included CNS TB (P = 0.032), higher white blood cell count (P = 0.045), and negative Toxoplasma serology (P = 0.032). Among patients at risk of unmasking TB-IRIS, factors associated with the occurrence of unmasking TB-IRIS included the absence of TB chemoprophylaxis (P = 0.017), female sex (P = 0.048), and hematopoietic-organ involvement of TB (P = 0.020).
Conclusion:
TB-IRIS is a severe complication in people living with HIV and is becoming increasingly frequent. Early identification of risk factors is essential to prevent its occurrence and to reduce associated mortality.
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