Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome-An Extempore Game of Misfiring with Defense Arsenals

• Authors: Ramachandran Vignesh, University of Kuala Lumpur; Pachamuthu Balakrishnan, Saveetha Inst Med & Tech Sci SIMATS; Hong Yien Tan, Xiamen Univ Malaysia; Yean Kong Yong, Xiamen Univ Malaysia; Vijayakumar Velu, Emory University; Marie Larsson, Linkoping University; Esaki M Shankar, Central University of Tamil Nadu
• Journal Title: PATHOGENS
• Volume: Volume 12, Number 2
• Publisher: MDPI | 2023-02-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/pathogens12020210
• Subjects: Biology, Microbiology; Health Sciences, Immunology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Microbiology; ART; biomarkers; HIV; inflammation; IRIS; tuberculosis; HIV-INFECTED ADULTS; ANTIRETROVIRAL THERAPY INITIATION; DIAGNOSED PULMONARY TUBERCULOSIS; MYCOBACTERIUM-TUBERCULOSIS; RISK-FACTORS; TB-IRIS; RESTORATION DISEASE; CASE-DEFINITION; TREATMENT OUTCOMES; CELL-ACTIVATION

Abstract

The lethal combination involving TB and HIV, known as “syndemic” diseases, synergistically act upon one another to magnify the disease burden. Individuals on anti-retroviral therapy (ART) are at risk of developing TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). The underlying inflammatory complication includes the rapid restoration of immune responses following ART, eventually leading to exaggerated inflammatory responses to MTB antigens. TB-IRIS continues to be a cause of morbidity and mortality among HIV/TB coinfected patients initiating ART, and although a significant quantum of knowledge has been acquired on the pathogenesis of IRIS, the underlying pathomechanisms and identification of a sensitive and specific diagnostic marker still remain a grey area of investigation. Here, we reviewed the latest research developments into IRIS immunopathogenesis, and outlined the modalities to prevent and manage strategies for better clinical and diagnostic outcomes for IRIS.