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Special ArticleOpen Access
Immune Reconstitution Inflammatory Syndrome in HIV-Infected Patients with Tuberculosis
Tuberculosis (TB) remains an important problem in patients with human immunodeficiency virus
(HIV) infection and acquired immune deficiency syndrome (AIDS). Concomitant administration therapy of
both TB and HIV is fraught with difficulties. Despite the fact that the use of highly active antiretroviral therapy
(HAART) led to significant improve quality of life and decrease morbidity including mortality-associated to
HIV/AIDS, adverse drug effects lead to interruptions in both HIV and TB therapy. In addition, an important
problem when HAART is initiated in patients with TB is the possibility of developing immune reconstitution
inflammatory syndrome (IRIS). A six-month regimen consisting of isoniazid, rifampicin, pyrazinamide, and
ethambutal for two months followed by isoniazid and rifampicin for four months is a standard regimen for the
treatment of known or presumed drug-susceptible TB disease. The following strategy may minimize the risk of
IRIS. Patients with CD4 cell counts < 100 cells/mm3, efavirenz-based HAART regimen is recommended and
should be initiated as soon as the patients can tolerate TB treatment. Patients with CD4 cell counts 100-350
cells/mm3, HAART should be started at two months after TB treatment initiation. HAART should be deferred
with closed follow-up of CD4 cell counts if patients have CD4 cell counts > 350 cells/mm3.
Keyword: AIDS, HIV, Tuberculosis, Immune reconstitution inflammatory syndrome, Immune reconstitution
syndrome, Acquired immunodeficiency syndrome
(HIV) infection and acquired immune deficiency syndrome (AIDS). Concomitant administration therapy of
both TB and HIV is fraught with difficulties. Despite the fact that the use of highly active antiretroviral therapy
(HAART) led to significant improve quality of life and decrease morbidity including mortality-associated to
HIV/AIDS, adverse drug effects lead to interruptions in both HIV and TB therapy. In addition, an important
problem when HAART is initiated in patients with TB is the possibility of developing immune reconstitution
inflammatory syndrome (IRIS). A six-month regimen consisting of isoniazid, rifampicin, pyrazinamide, and
ethambutal for two months followed by isoniazid and rifampicin for four months is a standard regimen for the
treatment of known or presumed drug-susceptible TB disease. The following strategy may minimize the risk of
IRIS. Patients with CD4 cell counts < 100 cells/mm3, efavirenz-based HAART regimen is recommended and
should be initiated as soon as the patients can tolerate TB treatment. Patients with CD4 cell counts 100-350
cells/mm3, HAART should be started at two months after TB treatment initiation. HAART should be deferred
with closed follow-up of CD4 cell counts if patients have CD4 cell counts > 350 cells/mm3.
Keyword: AIDS, HIV, Tuberculosis, Immune reconstitution inflammatory syndrome, Immune reconstitution
syndrome, Acquired immunodeficiency syndrome
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