Tuberculosis immune reconstitution inflammatory syndrome: profile of an enigmatic condition

Tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS) in HIV co-infected TB patients is an intriguing but frequently occurring phenomenon experienced by patients after initiating anti retroviral therapy. It is characterized by paradoxical worsening of clinical and radiological manifestations of TB, after initiation of highly active antiretroviral therapy, when improvement in the general condition of the patient is usually anticipated. This paradoxical reaction is brought about by a cascade of inflammatory reactions triggered by the recovery of the immune system both in quality and quantity. Manifestations of TB-IRIS range from mild self-limiting symptoms to life threatening compressive syndromes that could rarely be fatal. Often, this condition is confused with treatment failure or drug toxicity, which could lead to unnecessary drug interruption or substitution. Recognition of this syndrome assumes significance in the context of these two diseases, which mandate prolonged therapy with very high adherence to achieve the desired results. This article provides an overview of the risk factors, pathogenesis, clinical presentation, available diagnostic tools and treatment strategies for TB-IRIS with impli-cations for patients and personnel involved in TB/HIV care