Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 199, Issue 3, Pages 437-444Publisher
OXFORD UNIV PRESS INC
DOI: 10.1086/595985
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Funding
- National Institutes of Health [HL71554, K24 AI065298]
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Antiretroviral therapy (ART) has beneficial effects on mortality and lowers the incidence of diseases caused by opportunistic infections, such as tuberculosis (TB). Although ART has sustained long-term benefits, the risk of TB is high during the first 3 months after ART initiation. Among cases of ART-associated TB, we define unmasked TB as that which occurs in patients with reactivation disease who develop clinically recognizable TB after ART with the restoration of previously acquired TB antigen-specific functional immune responses. TB cases with clinical evidence of an inflammatory syndrome are a subset of these unmasked cases, which we define as unmasked TB-immune reconstitution inflammatory syndrome. With more widespread use of ART in areas with a high prevalence of TB, unmasked TB will likely become more common. TB diagnostics with improved sensitivity and specificity are urgently needed to detect subclinical TB before it is unmasked.
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